Pediatric Respiratory Acidosis Clinical Presentation

Updated: Jun 05, 2014
  • Author: Mithilesh K Lal, MD, MBBS, MRCP, FRCPCH, MRCPCH(UK); Chief Editor: Timothy E Corden, MD  more...
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Presentation

History

The following questions should be asked in the course of the history:

  • Does the patient have a history of headaches? (With chronic hypercapnia, headaches typically occur at nighttime or when the patient awakens in the morning)

  • Does the patient have disturbed sleep patterns? (Chronic hypercapnia can disturb sleep patterns, leading to a reversed sleep-wake cycle)

  • Is the patient irritable or anxious, or is he or she having trouble concentrating?

  • Does the patient have a possible or known exposure to sedatives (eg, narcotics, benzodiazepines, tricyclic antidepressants)? Is the patient recovering from a procedure in which general anesthesia was used?

  • Does the patient have symptoms of neuromuscular weakness or paralysis? (Such symptoms might include bulbar dysfunction suggesting myasthenia gravis, proximal or distal weakness suggesting a myopathy or Guillain-Barré syndrome, and apnea associated with a traumatic injury suggesting an injury to the cervical spinal cord)

  • Does the patient have a long-standing pulmonary disease, such as bronchopulmonary dysplasia, cystic fibrosis, asthma, or emphysema?

  • Does the patient have an acute change in mental status (eg, signs of stroke, postictal state)? If so, is the change in mental status associated with a fever, which may suggest encephalitis or meningitis? Does the patient have signs of increased intracranial pressure (eg, headaches, visual changes, or emesis)?

  • Does the patient have a potential for an anaphylactic reaction?

  • Does the patient have a potential traumatic mechanism leading to brain injury?

Next:

Physical Examination

Neurologic findings associated with respiratory acidosis include the following:

  • Early signs include anxiety, disorientation, confusion, and lethargy

  • Somnolence or coma occurs when the arterial partial pressure of carbon dioxide (Pa CO2) exceeds 70 mm Hg

  • Tremor, myoclonus, or asterixis are occasionally seen

  • Brisk deep tendon reflexes are seen in mild-to-moderate respiratory acidosis

  • Depressed deep tendon reflexes are seen in severe respiratory acidosis

  • Papilledema or blurring of the optic disc may be present

Cardiovascular findings associated with respiratory acidosis include the following:

  • Tachycardia

  • Bounding arterial pulses

  • Hypotension (severe respiratory acidosis or acidemia and hypoxemia)

Cutaneous findings associated with respiratory acidosis include the following:

  • Warm, flushed, or mottled skin

  • Diaphoresis

Respiratory findings associated with respiratory acidosis include the following:

  • Acute hypercapnia is seen in association with increase work of breathing

  • Tachypnea, dyspnea, or deep labored breaths may be observed

  • Accessory muscle use and nasal flaring are usually present

  • With central or peripheral nervous system disease, respiratory distress may not be present

  • Decreased aeration, crackles, wheezes, or other signs of airway disease may be observed

  • Clubbing is a sign of chronic respiratory disease

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