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Respiratory acidosis
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Respiratory acidosis

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Contributors: Christine Osborne MD, Mary Anne Morgan MD
Other Resources UpToDate PubMed


A condition that raises the serum partial pressure of carbon dioxide (pCO2) and lowers the serum pH. Presentation varies based on the acuity of onset as well as the underlying cause.
  • Typical symptoms associated with a rapid increase in pCO2 include anxiety, dyspnea, confusion, hallucination, and psychosis; may progress to coma.
  • A more gradual increase, as is seen with chronic respiratory acidosis, may cause memory impairment, sleep disturbances, personality changes, daytime somnolence, coordination impairment, tremors, myoclonic jerks, or asterixis.
Common conditions associated with respiratory acidosis include asthma, emphysema, acute respiratory distress syndrome, medications such as morphine and anesthetics, stroke, infection, neuromuscular disorders, obesity hypoventilation syndrome, and secondary effects of mechanical ventilation.
  • Acute respiratory acidosis – Acute hypercapnia typically follows sudden obstruction of the airway or generalized bronchospasm. The acute compensatory response for respiratory acidosis is an increase in the serum bicarbonate concentration by 1 meq/L for every 10 mmHg elevation in pCO2.
  • Chronic respiratory acidosis – Chronic hypercapnia occurs in end-stage chronic obstructive pulmonary disease, restrictive lung disease with ventilatory muscle fatigue, or advanced states of intrapulmonary and extrapulmonary restrictive lung disease. With chronic acidosis, the kidneys increase acid excretion allowing for generation of additional HCO3, and the renal tubule increases HCO3 reabsorption, a process that takes 3-5 days to complete. The chronic response leads to a 4 meq/L increase in the serum bicarbonate concentration per 10 mmHg elevation in pCO2.


E87.2 – Acidosis

12326000 – Respiratory acidosis

Differential Diagnosis & Pitfalls

Metabolic acidosis

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated: 10/14/2016
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Respiratory acidosis
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Respiratory acidosis : Headache, Anxiety, Delirium, Sleep disturbance, Dyspnea, Tremor
Copyright © 2018 VisualDx®. All rights reserved.