Respiratory Acidosis

What is respiratory acidosis?

Respiratory acidosis is a condition that causes lower-than-normal blood pH because of increased acids in your blood. Your blood needs a specific pH balance to function properly. The pH scale is the levels of acids and bases in your blood. The pH scale ranges from 0 (very acidic) to 14 (very basic or alkaline). A normal pH range in your blood is between 7.35 to 7.45.

It develops because your lungs can’t adequately remove all the carbon dioxide (CO2) your body produces. Sudden respiratory acidosis may be fatal. Call 911 or any emergency number and seek medical help immediately if you have difficulty breathing or are choking.

What are the types of respiratory acidosis?

There are two types of respiratory acidosis:

• Acute respiratory acidosis. Acute respiratory acidosis occurs when carbon dioxide accumulates quickly in your lungs.
• Chronic respiratory acidosis. Chronic respiratory acidosis occurs gradually.

You can have both types of respiratory acidosis at the same time. If you have chronic respiratory acidosis, you may also develop a condition that causes acute respiratory acidosis.

Who does respiratory acidosis affect?

Anyone can get respiratory acidosis. It occurs as a result of:

• Diseases that affect your lungs or other parts of your respiratory system (pulmonary disease).
• Inability of the muscles in your respiratory system to work or create enough pressure (respiratory muscle fatigue).
• Conditions that affect how air circulates in your lungs.

What are respiratory acidosis symptoms?

Respiratory acidosis symptoms vary according to how long you’ve had the condition and its severity. The initial symptoms include:

• Anxiety.
• Blurred vision.
• Confusion.
• Discolored (blue, purple, gray-green, grey or white) skin tone from lack of oxygen (cyanosis).
• Headache.
• Shortness of breath (dyspnea).
• Wheezing.

If you don’t treat respiratory acidosis or if you have a severe case, your symptoms may include:

• Feeling extremely tired (fatigue).
• Muscle twitching (myoclonus).
• Behavioral changes.
• Seizure.
• Coma.

Chronic (long-lasting) respiratory acidosis symptoms may include:

• Fatigue, especially during the daytime.
• Heart failure.
• High blood pressure (hypertension).
• High red blood cell levels (polycythemia).
• Loss of coordination.
• Memory loss.

What are the main causes of respiratory acidosis?

Breathing problems are the main cause of respiratory acidosis. However, the causes may depend on what type you have.

Chronic respiratory acidosis causes

Chronic respiratory acidosis causes include:

• Acute pulmonary edema.
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
• Asthma.
• Chronic obstructive pulmonary disease (COPD).
• Conditions that affect the nerves that control your muscles (neuromuscular disorders), including multiple sclerosis (MS) and muscular dystrophy.
• Obesity that affects how far your lungs expand.
• Pulmonary fibrosis.
• Scoliosis.

Acute respiratory acidosis causes

Acute respiratory acidosis causes include:

• Asthma.
• COPD.
• Overuse of substances that affect your central nervous system, including alcohol, amphetamines and opioids.
• Emphysema.
• Pneumonia.
• Sleep apnea.

How is respiratory acidosis diagnosed?

A healthcare provider will ask about your symptoms and conduct a physical examination.

The provider may order several tests to confirm a respiratory acidosis diagnosis.

What tests will be done to diagnose respiratory acidosis?

A healthcare provider may order the following tests to confirm a respiratory acidosis diagnosis:

• Arterial blood gas (ABG). An ABG test measures the carbon dioxide and oxygen levels in your blood.
• Basic metabolic panel (BMP). A BMP measures different substances in your body to determine your body’s chemical balance and metabolism.
• Chest X-ray. This imaging test creates an image of your chest, including your lungs.
• CO2 blood test. A provider will use a thin needle to withdraw a small amount of blood from a vein in your arm to measure the amount of carbon dioxide in your blood.
• Computed tomography (CT) scan. This imaging test uses a series of X-rays to build a 3D image of your lungs.
• Electrolyte panel. An electrolyte panel measures the levels of certain electrolytes in your blood. Some electrolytes will be higher or lower if you have respiratory acidosis.
• Pulmonary function tests (PFTs). PFTs measure how well your lungs work.

How do you manage respiratory acidosis?

A healthcare provider will treat the underlying conditions that cause respiratory acidosis. This may include:

• Continuous positive airway pressure (CPAP) machine. A CPAP machine treats sleep apnea by delivering a steady supply of pressurized air through a mask while you sleep.
• Mechanical ventilation. A mechanical ventilator helps you breathe if you have severe respiratory acidosis.
• Medications. Your provider may prescribe medications to treat any conditions that affect your lungs or airways.
• Oxygen therapy. Oxygen therapy helps increase your blood oxygen level.

What medication is given for respiratory acidosis?

A healthcare provider may use or prescribe one or more of the following medications to treat an underlying condition that causes acute respiratory acidosis:

• Antibiotics. Antibiotics help fight bacterial infections in your lungs.
• Bronchodilators. Bronchodilators help relieve lung condition symptoms by relaxing the muscles around your airways.
• Corticosteroids. Corticosteroids are anti-inflammatory drugs that also help reduce mucus production in your airways.
• Diuretics. Diuretics help clear extra fluid out of your body and reduce blood pressure.
• Naloxone. If a provider suspects an opioid overdose, they may give you naloxone (Narcan®) through a nasal spray or a vein in your arm.
• Quit-smoking medicines. Nicotine patches, lozenges and gum can help you quit smoking. Non-nicotine medicines include bupropion and varenicline.

How can I prevent respiratory acidosis?

The following can help prevent possible causes of respiratory acidosis:

• Quit smoking or using tobacco products, such as e-cigarettes or vape pens.
• Exercise regularly.
• Maintain a healthy weight for you.
• Use a prescribed CPAP machine regularly.
• Take sedatives with caution. Follow all directions on the label, only take the prescribed amount and never combine sedatives with alcohol.

What can I expect if I have respiratory acidosis?

It’s difficult for healthcare providers to determine your outlook if you have respiratory acidosis. Your response to treatment depends on what’s causing your symptoms. Talk to a provider. They’ll tell you what to expect after a physical exam and testing.

When should I see a healthcare provider?

Seek medical help as soon as possible if you have symptoms of severe respiratory acidosis.

Talk to a healthcare provider if you have a lung condition and your symptoms suddenly get worse.

What questions should I ask a healthcare provider?

• How do you know I have respiratory acidosis?
• If I don’t have respiratory acidosis, what other condition could I have?
• Do I have acute or chronic respiratory acidosis?
• Which tests do you recommend to confirm respiratory acidosis?
• What condition caused respiratory acidosis?
• What treatment do you recommend?

What is the difference between respiratory acidosis and respiratory alkalosis?

Respiratory acidosis is when your lungs can’t remove all the carbon dioxide that your body produces, so your blood pH is lower (more acidic) than normal.

Respiratory alkalosis is when hyperventilation prevents your lungs from removing excess carbon dioxide, so your blood pH is higher (more basic) than normal.

What is the difference between respiratory acidosis and metabolic acidosis?

Metabolic acidosis is when acids build up in your body fluids, either because your body produces too much acid or your kidneys don’t remove enough acids from your blood.

A note from Cleveland Clinic

Respiratory acidosis is a potentially fatal condition that causes acids to build up in your blood because your lungs can’t remove enough of the carbon dioxide that your body makes. Don’t ignore symptoms of respiratory acidosis. They’re your body’s way of telling you something isn’t right and that you should seek help. If you have any symptoms, talk to a healthcare provider. They can diagnose respiratory acidosis and recommend the best treatment for you.