Acute respiratory acidosis (eg. opioid overdose) – hyperventilation should correct the pH.

Avoid normal saline (hyperchloremic acidosis) – aggressive administration of normal saline (>30cc/kg/hr) may worsen acidosis. Excessive chloride administration impairs bicarbonate resorption in the kidneys.

Avoid respiratory depressing drugs (ie. opioids) – these will further depress ventilation and contribute to respiratory acidosis.

Packed red blood cells (PBRCs) – should be administered if the patient becomes anemic – this will help to avoid metabolic acidosis.

Avoid Hypothermia – Keep the patient normothermic.

Check the CO2 absorbent – if exhausted, the patient will be rebreathing CO2, which will contribute to respiratory acidosis

Considerations prior to extubation – get an ABG to ensure respiratory acidosis is reversed. Then, ensure respiratory rate, tidal volume, and EtCO2 are sufficient to be self-supporting.

Arterial pH represents the hydrogen ion concentration of the blood. The normal level is 7.35-7.45. Maintenance of this level is dependent on buffering systems and and compensatory mechanisms of the pulmonary and renal systems. Disturbance of any one of these systems can result in acidosis or alkalosis.

Buffering systems include: Bicarbonate and carbonic acid, hemoglobin, plasma proteins, and phosphates

Respiratory acidosis results from any situation in which the alveolar ventilation is decreased. This results in an increased concentration in dissolved plasma carbon dioxide. In essence, because the ventilation has been reduced, the carbon dioxide cannot be blown off as quickly, resulting in a builds-up of CO2 systemically. An example of this is an opioid overdose.

The rapid response/compensation to acidosis in general is an increase in respiratory rate.

The slower response/compensation to acidosis is the renal response – urinary excretion or retention of acids (eg. hydrogen ions) and/or bases (eg. bicarbonate ions).

Oxyhemoglobin Dissociation Curve: will demonstrate a shift to the right with high CO2 and low pH

Uncompensated Respiratory Acidosis: pH > 45 + normal HCO3 (22-26). Example: Acute opioid overdose

Compensated Respiratory Acidosis: pH normal + PaCO2 > 45 + HCO3 > 26. Example: COPD.