Respiratory Acidosis Treatment in Delhi, India

Respiratory acidosis is a medical condition characterised by an imbalance in the body's pH levels, resulting from inadequate removal of carbon dioxide (CO2) by the lungs. Normally, the lungs play a crucial role in maintaining the body's acid-base balance by expelling excess CO2, which is produced as a by-product of cellular metabolism. However, in respiratory acidosis, the lungs are unable to eliminate CO2 efficiently, leading to its accumulation in the bloodstream. This excess CO2 reacts with water in the body to form carbonic acid, thereby lowering the pH of the blood and causing it to become more acidic.

Respiratory acidosis comes in two main forms, distinguished by how quickly it develops and the body's response:

Chronic Respiratory Acidosis

Chronic respiratory acidosis develops gradually over time and is typically associated with chronic respiratory conditions that impair lung function persistently, resulting in a chronic retention of carbon dioxide. This type of respiratory acidosis tends to have a slower onset, with symptoms worsening gradually over an extended period.

Acute Respiratory Acidosis

Acute respiratory acidosis develops rapidly and is often associated with sudden impairment of ventilation, leading to an inability to expel carbon dioxide adequately from the body. This type of respiratory acidosis typically occurs over a short period, and its symptoms like rapid, shallow breathing, confusion, anxiety, and bluish skin can manifest quickly.

Several factors can contribute to the development of respiratory acidosis:

• Lung Diseases: Chronic lung diseases such as chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and bronchiectasis can impair lung function and decrease the ability to exhale CO2 effectively

• Airway Obstruction: Conditions that cause airway obstruction, such as severe asthma attacks, obstructive sleep apnoea, or physical blockages in the airways, can hinder the expulsion of CO2 from the lungs.

• Neuromuscular Disorders: Disorders affecting the nerves or muscles involved in breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, Guillain-Barré syndrome, and myasthenia gravis, can weaken respiratory muscles and reduce the efficiency of ventilation.

• Central Nervous System Disorders: Conditions impacting the brainstem or respiratory centres in the brain can disrupt the control of breathing, leading to hypoventilation and respiratory acidosis. Examples include brainstem strokes, traumatic brain injury, and drug intoxication.

• Chest Wall Deformities: Structural abnormalities of the chest wall, such as kyphoscoliosis, severe obesity, or conditions like flail chest, can restrict lung expansion and impair respiratory mechanics, resulting in inadequate ventilation and CO2 retention.

• Respiratory Depressants: Drugs or substances that depress the respiratory drive or reduce respiratory muscle function can lead to hypoventilation and respiratory acidosis. Examples include opioids, sedatives, anaesthetics, and alcohol.

• Acute Respiratory Conditions: Acute conditions such as pneumonia, pulmonary oedema, acute respiratory distress syndrome (ARDS), or severe lung infections can impair gas exchange and lead to respiratory acidosis.

• Hypoventilation Syndromes: Conditions characterised by reduced ventilatory drive or inadequate respiratory effort, such as obesity hypoventilation syndrome (OHS), can result in chronic CO2 retention and respiratory acidosis.

Symptoms of Acute Respiratory Acidosis

• Rapid, shallow breathing: This is the body's attempt to compensate for the build-up of carbon dioxide by expelling it more quickly.

• Confusion: As the pH of the blood becomes more acidic, it can affect the brain's function, leading to confusion, disorientation, and difficulty thinking clearly.

• Anxiety: The body's stress response can kick in due to the difficulty breathing, leading to feelings of anxiety and restlessness.

• Headache: Changes in blood flow and irritation of the nerves surrounding the brain can cause headaches in people with acute respiratory acidosis.

• Shortness of breath (dyspnoea): This is a common symptom of many respiratory problems, including respiratory acidosis. People may feel a sensation of not being able to get enough air.

• Bluish tint to the skin (cyanosis): This occurs when there's not enough oxygen in the bloodstream. The skin and lips may take on a bluish hue, especially in severe cases.

Symptoms of Chronic Respiratory Acidosis

• Morning Headaches: The build-up of carbon dioxide overnight can contribute to headaches upon waking in people with chronic respiratory acidosis.

• Excessive Daytime Sleepiness: People with chronic respiratory acidosis may experience fatigue and sleepiness throughout the day due to the body's efforts to compensate for low oxygen levels.

• Difficulty Concentrating: Changes in blood pH can affect brain function, leading to problems with focus and concentration.

• Breathlessness During Exertion: Even mild exertion can cause shortness of breath in people with chronic respiratory acidosis.

• Frequent Respiratory Infections: People with chronic respiratory problems are more prone to respiratory infections, which can further worsen their condition.

Diagnosing respiratory acidosis typically involves a combination of clinical evaluation, laboratory tests, and diagnostic imaging studies. Here are the key components of the diagnostic process:

• Clinical Assessment: A thorough medical history is obtained to identify risk factors, underlying medical conditions, and potential triggers for respiratory acidosis, such as chronic lung diseases, neuromuscular disorders, or recent exacerbations of respiratory acidosis signs and symptoms. Physical examination is conducted to assess respiratory rate, depth of breathing, lung sounds, oxygen saturation levels, and signs of respiratory distress or cyanosis (bluish discolouration of the skin).

• Arterial Blood Gas (ABG) Analysis: Arterial blood gas analysis is the cornerstone of diagnosing respiratory acidosis. A blood sample is drawn from an artery, usually the radial artery in the wrist, and analysed to measure arterial pH, partial pressure of carbon dioxide (PaCO2), and bicarbonate (HCO3-) levels. In respiratory acidosis, arterial pH is decreased (<7.35) due to accumulation of CO2, while PaCO2 levels are elevated (>45 mmHg). Bicarbonate levels may be elevated in compensation for acidosis.

• Pulmonary Function Tests (PFTs): Pulmonary function tests may be performed to assess lung function, including spirometry, which measures lung volumes and airflow rates, and diffusion capacity tests, which evaluate gas exchange in the lungs.

• PFTs can help identify underlying lung diseases such as COPD, asthma, or restrictive lung disorders that may contribute to respiratory acidosis.

• Chest X-ray or CT Scan: Imaging studies such as chest X-ray or computed tomography (CT) scan may be ordered to evaluate lung anatomy, detect signs of pneumonia, pulmonary oedema, or other structural abnormalities that could impair ventilation.

• Electrocardiogram (ECG or EKG): An electrocardiogram may be performed to assess cardiac function and detect any arrhythmias or changes associated with severe acidosis, such as widened QRS complex or peaked T waves.

• Laboratory Tests: Additional laboratory tests may be ordered to assess electrolyte imbalances, renal function, and other metabolic parameters that can be affected by respiratory acidosis.

• Monitoring and Serial ABGs: Continuous monitoring of arterial blood gases may be necessary, especially in critically ill patients or those receiving mechanical ventilation, to assess response to treatment and guide adjustments in therapy.

Treatment and management of respiratory acidosis aim to address the underlying cause, improve ventilation, restore acid-base balance, and prevent complications. The specific approach may vary depending on the severity of the condition, the presence of coexisting medical conditions, and individual patient factors. Here are the key components of treatment and management:

Addressing Underlying Cause

Identifying and treating the underlying cause of respiratory acidosis is essential. This may involve managing exacerbations of chronic lung diseases (e.g., COPD, asthma), treating infections (e.g., pneumonia), correcting airway obstructions, or optimising neuromuscular function.

Improving Ventilation

• Non Invasive Ventilation: Non-invasive ventilation (NIV) is a medical technique used to provide respiratory support to patients without the need for invasive procedures such as intubation. It involves the delivery of air or oxygen through a mask or nasal prongs, allowing patients to breathe more comfortably and effectively. NIV is commonly used to treat conditions such as chronic obstructive pulmonary disease (COPD), pneumonia, and acute respiratory distress syndrome (ARDS). By assisting the patient's natural breathing process, NIV can improve oxygenation and alleviate respiratory distress, reducing the need for invasive interventions and potentially shortening hospital stays. Mechanical Ventilation: In cases of respiratory failure or severe hypoventilation, mechanical ventilation may be necessary to support breathing and maintain adequate gas exchange. Different modes of ventilation, such as assist-control ventilation or pressure support ventilation, may be used based on individual patient needs.

Bronchodilator Therapy

Bronchodilators, such as beta-agonists or anticholinergics, may be prescribed to improve airway patency and reduce airway resistance in conditions like COPD and respiratory acidosis or asthma, facilitating better ventilation and gas exchange.

Assisted Cough Techniques

Techniques such as chest physiotherapy or mechanical insufflation-exsufflation may be employed to assist with clearing airway secretions and improving cough effectiveness in patients with neuromuscular weakness or impaired mucociliary clearance.

Managing Complications

Addressing complications of respiratory acidosis is crucial. This may include treating electrolyte imbalances, managing pulmonary hypertension or cor pulmonale, preventing respiratory infections, and preventing or managing acute respiratory distress syndrome (ARDS).

Monitoring and Supportive Care

Continuous monitoring of vital signs, arterial blood gases, and oxygen saturation levels is essential to assess response to treatment and guide adjustments in therapy.

In addition, supportive care measures, including adequate hydration, pain management, and nutritional support, may be necessary to optimise patient comfort and overall well-being.

Lifestyle Modifications

Lifestyle modifications such as quitting smoking, weight management, and avoidance of respiratory irritants can help prevent exacerbations and improve long-term respiratory function in individuals with chronic respiratory conditions.

Long-Term Management

Long-term management of respiratory acidosis involves regular follow-up visits with healthcare providers, adherence to prescribed medications and therapies, and proactive management of underlying chronic conditions to prevent recurrence and optimise respiratory function.

Overall, a multidisciplinary approach involving pulmonologists, critical care specialists, respiratory therapists, and other healthcare professionals is essential for the effective treatment and management of respiratory acidosis, with the goal of improving patient outcomes and quality of life.

Respiratory acidosis can lead to a number of serious complications if left untreated. Here's a breakdown of the potential consequences:

• Respiratory failure: When the lungs can't remove enough carbon dioxide and keep oxygen levels up, leading to a life-threatening situation.

• Coma: Severe cases of acidosis can disrupt the body's acid-base balance significantly, leading to unconsciousness.

• Cardiac Arrhythmias: The acidic environment disrupts the heart's electrical activity, causing irregular heartbeats.

• Shock: Life-threatening condition where the body's circulation weakens due to acidosis.

• Cor Pulmonale: Chronic high blood pressure in the lungs due to chronic acidosis strains the right heart ventricle.

• Pulmonary Hypertension: Chronic acidosis can contribute to this condition, putting strain on the heart and worsening breathing problems.

• Right heart failure: Untreated cor pulmonale can lead to this, where the heart struggles to pump blood from the right ventricle to the lungs.

• Cognitive Dysfunction: Long-term exposure to acidic blood can impact memory, concentration, and decision-making.

• Muscle Wasting: Chronic low oxygen levels can lead to muscle breakdown and weakness.

Preventing respiratory acidosis involves addressing underlying risk factors, optimising respiratory function, and adopting healthy lifestyle habits. Here are some strategies for prevention:

• Manage Chronic Respiratory Conditions: If you have a chronic respiratory condition such as chronic obstructive pulmonary disease (COPD), asthma, or obstructive sleep apnoea, work closely with your healthcare provider to manage your condition effectively. Follow your treatment plan, take prescribed medications regularly, and attend regular check-ups to monitor your lung function.

• Quit Smoking: Smoking is a significant risk factor for respiratory diseases and can exacerbate respiratory acidosis. If you smoke, quit smoking to improve lung function and reduce the risk of developing respiratory complications.

• Avoid Respiratory Irritants: Minimise exposure to environmental pollutants, allergens, and respiratory irritants such as air pollution, dust, chemical fumes, and second-hand smoke. Use appropriate protective gear when working in environments with potential respiratory hazards.

• Maintain a Healthy Weight: Obesity can contribute to respiratory problems and hypoventilation, increasing the risk of respiratory acidosis. Maintain a healthy weight through a balanced diet and regular exercise to support optimal respiratory function.

• Adhere to Medications: If you have neuromuscular disorders or conditions affecting respiratory muscles, follow your healthcare provider's recommendations for medications and therapies to optimise respiratory function and prevent respiratory complications.

• Practice Good Sleep Hygiene: Obstructive sleep apnoea and sleep-disordered breathing can contribute to respiratory disturbances and hypoventilation during sleep, leading to respiratory acidosis. Practise good sleep hygiene, maintain a regular sleep schedule, and seek treatment if you experience symptoms of sleep apnoea.

• Stay Hydrated: Adequate hydration helps maintain respiratory secretions and supports optimal lung function. Drink plenty of fluids throughout the day, especially in dry or hot environments, to prevent dehydration and promote effective respiratory function.

• Monitor Symptoms: Be vigilant about monitoring respiratory symptoms such as shortness of breath, wheezing, chest tightness, or changes in breathing patterns. Seek medical attention promptly if you experience worsening respiratory symptoms or signs of respiratory distress.

• Follow Up with Healthcare Provider: Attend regular follow-up appointments with your healthcare provider to monitor your respiratory health, assess lung function, and adjust treatment as needed to prevent respiratory complications and exacerbations.

Who does respiratory acidosis affect?

Respiratory acidosis can affect individuals of any age, but it is more common in people with chronic lung diseases such as chronic obstructive pulmonary disease (COPD), asthma, neuromuscular disorders, obesity hypoventilation syndrome, or those who have experienced acute respiratory conditions or injuries affecting breathing.

What is the difference between respiratory acidosis and alkalosis?

Respiratory acidosis occurs when there is an accumulation of carbon dioxide in the bloodstream, leading to decreased pH levels and acidity. In contrast, respiratory alkalosis occurs when there is a decrease in carbon dioxide levels in the blood, resulting in increased pH levels and alkalinity.

How do you reduce respiratory acidosis?

To reduce respiratory acidosis, it's essential to address the underlying cause, optimise respiratory function, and restore acid-base balance. This may involve treating lung diseases, improving ventilation with supplemental oxygen or mechanical ventilation, and managing complications associated with acidosis.

What is the difference between respiratory acidosis and metabolic acidosis?

Respiratory acidosis results from inadequate removal of carbon dioxide by the lungs, leading to increased carbon dioxide levels and acidity in the blood. Metabolic acidosis, on the other hand, occurs due to an excess of acids or a loss of bicarbonate in the body, leading to decreased bicarbonate levels and acidity in the blood.

Who treats respiratory acidosis?

Respiratory acidosis is typically treated by healthcare professionals specialising in respiratory medicine, such as pulmonologists, critical care physicians, respiratory therapists, and intensive care unit (ICU) nurses. Treatment may also involve collaboration with other specialists, depending on the underlying cause.

Can you recover from respiratory acidosis?

Yes, respiratory acidosis can often be reversed with appropriate treatment and management. Recovery depends on the underlying cause, the severity of the condition, and timely intervention to restore normal respiratory function and acid-base balance.

What foods reduce acidosis?

Foods that are alkaline-forming, such as fruits, vegetables, legumes, and nuts, can help reduce acidity in the body and promote a more alkaline pH balance. Examples include leafy greens, citrus fruits, berries, and almonds.

Can acidosis be cured?

Acidosis can often be managed and controlled with proper respiratory acidosis treatment, lifestyle modifications, and dietary changes. However, curing acidosis may depend on addressing the underlying cause and achieving optimal physiological balance.

How can I reverse acidosis naturally?

Reversing acidosis naturally may involve maintaining a balanced diet rich in alkaline-forming foods, staying hydrated, reducing stress, getting regular exercise, and avoiding factors that contribute to acidosis, such as smoking and excessive alcohol consumption.

Can acidosis damage kidneys?

Prolonged or severe acidosis can potentially affect kidney function and lead to complications such as kidney stones, impaired kidney function, or metabolic disorders. It's essential to manage acidosis promptly to prevent kidney damage.

What vitamins help with acidosis?

Certain vitamins and minerals, such as vitamin B6, vitamin B12, magnesium, and potassium, may help support acid-base balance and metabolic function. However, it's important to consult with a healthcare provider before taking supplements to address acidosis.

What should I do if I feel short of breath due to respiratory acidosis?

Rest in a comfortable, upright position. If you have oxygen therapy prescribed by your doctor, use it as directed. Seek immediate medical attention if your shortness of breath worsens.

Will respiratory acidosis affect my sleep?

Yes, both acute and chronic forms can disrupt sleep patterns. Discuss sleep apnoea testing with your doctor if you experience frequent nighttime awakenings or daytime sleepiness.

Reviewed by Dr. Vivek Nangia, Principal Director & Head, Pulmonology on 25-Apr-24.