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Acute respiratory alkalosis associated with low minute ventilation in a patient with severe hypothyroidism

Canadian Journal of Anesthesia volume 46, pages 185–189 (1999)Cite this article

Abstract

Purpose

Patients with severe hypothyroidism present unique challenges to anesthesiologists and demonstrate much increased perioperative risks. Overall, they display increased sensitivity to anesthetics, higher incidence of perioperative cardiovascular morbidity, increased risks for postoperative ventilatory failure and other physiological derangements. The previously described physiological basis for the increased incidence of postoperative ventiiatory failure in hypothyroid patients includes decreased central and peripheral ventiiatory responses to hypercarbia and hypoxia, muscle weakness, depressed central respiratory drive, and resultant alveolar hypoventilation. These ventiiatory failures are associated most frequently with severe hypoxia and carbon dioxide (CO2) retention. The purpose of this clinical report is to discuss an interesting and unique anesthetic presentation of a patient with severe hypothyroidism.

Clinical features

We describe an unique presentation of ventilatory failure in a 58 yr old man with severe hypothyroidism. He had exceedingly low perioperative respiratory rate (3–4 bpm) and minute ventilation volume, and at the same time developed primary acute respiratory alkalosis and associated hypocarbia (PETCO2 =320-22 mmHg).

Conclusion

Our patient’s ventiiatory failure was based on unacceptably low minute ventilation and respiratory rate that was unable to sustain adequate oxygenation. His profoundly lowered basal metabolic rate and decreased CO2 production, resulting probably from severe hypothyroidism, may have resulted in development of acute respiratory alkalosis in spite of concurrently diminished minute ventilation.

Résumé

Objectif

Les patients atteints d’hypothyroïdie sévère représentent tout un défi pour les anesthésiologistes étant donné les risques périopératoires très élevés. Dans l’ensemble, ils affichent une grande sensibilité aux anesthésiques, une forte incidence de morbidité cardiovasculaire périopératoire, des risques importants d’insuffisance ventilatoire postopératoire et d’autres désordres physiologiques. Les bases physiologiques, précédemment décrites, de l’incidence accrue d’insuffisance ventilatoire postopératoire chez ces patients comprennent des réponses ventilatoires centrales et périphériques diminuées à l’hypercapnie et à l’hypoxie, la faiblesse musculaire, la baisse de stimulation respiratoire centrale et l’hypoventilation alvéolaire qui en résulte. Ces défaillances ventilatoires sont le plus souvent associées à une hypoxie sévère et à une rétention de gaz carbonique (CO2). L’objectif du présent article est de commenter la présentation anesthésique unique et intéressante d’un patient atteint d’hypothyroïdie sévère.

Éléments cliniques

Il s’agit d’un homme de 58 ans atteint d’hypothyroïdie sévère. Il présentait une fréquence respiratoire (3–4 bpm) et une ventilation-minute périopératoires extrêmement basses et il a, au même moment, développé une alcalose respiratoire primaire aiguë et une hypocarbie associée (PETCO2 ≈ 320–22 mmHg).

Conclusion

La défaillance ventilatoire était basée sur d’inacceptables basses fréquence respiratoire et ventilationminute qui ne permettaient pas d’entretenir une oxygénation suffisante. La vitesse extrêmement faible du métabolisme basal et la production réduite de CO2, résultant probablement de l’hypothyroïdie sévère, ont pu conduire au développement d’une alcalose respiratoire aiguë malgré la diminution simultanée de la ventilation-minute.

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Author information

Author notes

  1. Matthew Levine

    Present address: Department of Anesthesiology, Saint Vincent’s Medical Center, New York Medical College, New York, NY

Affiliations

  1. Department of Anesthcsiology, College of Physicians and Surgeons of Columbia University, New York, NY, USA

    H. Thomas Lee & Matthew Levine

Authors
  1. H. Thomas Lee
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  2. Matthew Levine
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Correspondence to H. Thomas Lee.

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Lee, H.T., Levine, M. Acute respiratory alkalosis associated with low minute ventilation in a patient with severe hypothyroidism. Can J Anesth 46, 185–189 (1999). https://doi.org/10.1007/BF03012556

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Keywords

  • Hypothyroidism
  • Tidal Volume
  • Basal Metabolic Rate
  • Etomidate
  • Minute Ventilation