Urgent considerations

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Nearly all causes of acute respiratory acidosis can develop into life-threatening situations. The primary concern in these patients is impending respiratory failure.

Initial emergent treatment for respiratory acidosis, irrespective of the underlying cause, involves immediate assessment of the patient with basic stabilization (airway, ventilatory, cardiovascular support) and rapid identification of potential etiologies via a thorough secondary survey.

Initial assessment

Once respiratory acidosis is identified, the first objective is to determine the stability of the patient and provide airway, ventilatory, or cardiovascular support where necessary.

For patients with obtundation, hemodynamic instability, or evidence of respiratory muscle fatigue (accessory muscle use, dyspnea, tachypnea), consideration should be given to initiating mechanical ventilatory support and transfer to a monitored setting (e.g., intensive care unit) prior to further investigative studies.[5]​​[6] Assessment for hypoxia should be completed, with supplemental oxygen provided as clinically indicated.[1]

Further assessment

Once the patient is stabilized, evaluation for serious causes of respiratory acidosis should be initiated to allow prompt and specific treatment of the individual underlying cause.

Laboratory tests to consider should include the following:

  • Arterial blood gas

  • Complete blood count to evaluate for polycythemia or elevated white blood cell count

  • Electrolyte panel to check for severe electrolyte derangements

  • Toxicology testing for possible drug ingestion

  • Lumbar puncture to evaluate for central nervous system (CNS) infection.

Imaging would include the following depending on suspected causes:

  • Imaging of the chest (chest x-ray or computed tomography) to evaluate for serious parenchymal lung disease (pneumonia, cardiogenic pulmonary edema, pneumothorax).

  • Urgent computed tomography scanning of the brain to screen for CNS causes, such as infarction, hemorrhage, or trauma.

Management of respiratory acidosis may include ventilatory support (invasive or noninvasive) and further specific medical therapies for treatment of the causative pathophysiology.[3][6][7][8]

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