Respiratory Acidosis in Pediatrics
Respiratory Acidosis in Pediatrics
Respiratory Acidosis is a condition where in the body’s pH level is less than 7.35 and the PaCO2 is greater than 42 mm Hg. This can be caused by factors that decrease a child’s respiratory effort. Usually, slow or shallow breathing will accumulate and build up carbon dioxide, when combined with water, this forms what we call carbonic acids and eventually leads to acidosis (increased pCO2 and decreased pH). The child would usually be confused, lethargic, disoriented.
Causes
Resiratory acidosis is commonly brought about by inadequate excretion of CO2. These conditions usually predispose respiratory acidosis:
• Inadequate ventilation (increases plasma CO2)
• Alveolar hypoventilation
• Increased pCO2
• Central nervous system depression
• Chronic respiratory disease
• Inadequate mechanical ventilation
• Pneumothorax
• Atelectasis
• Sedative overdose
• Sleep apnea syndrome
• Neuromuscular disease
• Pulmonary edema
• Aspiration of foreign objects
• Acute respiratory distress syndrome
• Diseases that destructs respiratory muscles:
o Guillan Barre syndrome
o Muscular dystrophy
o Myasthenia gravis
• Chronic acidosis occurs with:
o Chronic emphysema
o Bronchitis
o Obstructive sleep apnea
o Obesity
Manifestations
The following would usually manifest in a child with respiratory acidosis:
• Dyspnea
• Tachycardia
• Cyanosis
• Increased intracranial pressure
• Central Nervous system depression
• Cerebrovascular vasodilation
• Increased cerebral blood flow
• Ventricular fibrillation
• Increased use of accessory muscles
• Sudden hypercapnia
• Increased pulse
• Increased blood pressure
• Mental cloudiness
• Feeling of fullness in the head
• Papilledema
• Dilated conjunctival blood vessels
• Hyperkalemia
Assessment and Diagnosis
The following assessment and diagnostic tools are essential to confirm the presence of respiratory acidosis:
• Arterial blood gas studies
o Reveals a pH level that is less than 7.35
o Reveals a PaCO2 that is greater than 42 mm Hg
o Reveals a variation in the bicarbonate levels
• Serum electrolyte studies
• Chest X – ray –this will determine any presence of respiratory malady or disease
• Drug screen test – determine and will confirm any overdose
• Electrocardiogram (ECG) – will recognize cardiac involvement (from chronic pulmonary disease)
Management
• Managing respiratory acidosis focuses on improving the child’s ventilation.
• Medications such as bronchodilators are indicated and given as ordered. This will reduce bronchial spasms.
• For infections, antibiotics are given as ordered.
• For pulmonary emboli, anticoagulants and thrombolytics are administered as ordered.
• Pulmonary hygiene is initiated; if possible, the patient should be free of any pulmonary congestion.
• Hydration is very important; an average of 3 liters is advisable to facilitate mucus drainage.
• Oxygen therapy is also initiated.
• Proper use and monitoring of mechanical ventilation.
• Assist the patient in a semi – Fowler’s position (this position facilitates chest expansion).
Byron Webb Romero, RN, MSN
Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.
