Abstract
C. S. is a 51-year-old, morbidly obese black male, with a history of tobacco smoking, crack cocaine abuse, chronic obstructive pulmonary disease (COPD) and an elevated left diaphragm following a left cervical blunt trauma. He was admitted for gradual exacerbation of his baseline shortness of breath. He reported increased cough and greenish sputum production. He had clinical symptoms and signs suggestive of obstructive sleep apnea. His physical examination was remarkable for morbid obesity, weighing 324 lbs (147.3 kg), increased respiratory rate of 30 breaths per minute, supraclavicular fullness, use of accessory respiratory muscles, and decreased breath sounds bilaterally at lung bases. His arterial blood gases (ABG) show pH 7.21, PaCO2 88 mmHg, PaCO2 45 mmHg, and HCO3 32 mEq/L. His oxygen saturation while breathing room air was 76 %.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Adrogue HJ, Madias N. Secondary responses to altered acid-base status: the rules of engagement. J Am Soc Nephrol. 2010;21(6):920–3.
Miller’s Anesthesia, 7th ed. Chapter 49-Perioperative acid-base balance. http://www.mdconsult.com/books. Accessed 11 Jan 2011.
West JB, Wagner PD. Pulmonary gas exchange. Am J Respir Crit Care Med. 1998;157:S82–S7.
Cruickshank S, Hirschauer N. The alveolar gas equation. Contin Educ Anaesth Crit Care Pain. 2004;4(1):24–7.
Adrogue HJ, Madias N. Management of life-threatening acid-base disorders: first of two parts. N Engl J Med. 1998;338(1):26–34.
Mason: Murray and Nadel’s textbook of respiratory medicine, 5th ed. http://www.mdconsult.com/books. Accessed 28 Jan 2011.
Adrogue HJ. Diagnosis and management of severe respiratory acidosis: a 65-year-old man with a double-lung transplant and shortness of breath. Am J Kidney Dis. 2010;56(5):994–1000.
McGarvey JM, Pollack CV. Heliox in airway management. Emerg Med Clin North Am. 2008;26(4):905–20. viii. Review.
Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004;(1):CD004104. Review.
Naloxone: Drug information. http://www.uptodate.com. Accessed 11 Jan 2011.
Littleton SW, Mokhlesi B. The pickwickian syndrome-obesity hypoventilation syndrome. Clin Chest Med. 2009;30(3):467–78. vii-viii.
Adrogue HJ, Gennari FJ, Galla JH, Madias N. Assessing acid-base disorders. Kidney Int. 2009;76(12):1239–47.
Piper AJ, Wang D, Yee BJ, Barnes DJ, Grunstein RR. Randomised trial of CPAP vs bilevel support in the treatment of obesity hypoventilation syndrome without severe nocturnal desaturation. Thorax. 2008;63(5):395–401.
Dabal LA, BaHammam AS. Obesity hypoventilation syndrome. Ann Thorac Med. 2009;4(2):41–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Arcila, A., Shafazand, S. (2013). Respiratory Acidosis. In: Lerma, E., Rosner, M. (eds) Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4454-1_14
Download citation
DOI: https://doi.org/10.1007/978-1-4614-4454-1_14
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-4453-4
Online ISBN: 978-1-4614-4454-1
eBook Packages: MedicineMedicine (R0)