Neurologic Presentations of Acid-Base Imbalance, Electrolyte Abnormalities, and Endocrine Emergencies


Accurate identification of nervous system dysfunction is vital in the assessment of any multisystem disorder. The neurologic manifestations of acid-base disturbances, abnormal electrolyte concentrations, and acute endocrinopathies are protean and typically determined by the acuity of the underlying derangement. Detailed history and physical examination may guide appropriate laboratory testing and lead to prompt and accurate diagnosis. Neurologic manifestations of primary and secondary systemic disorders are frequently encountered in all subspecialties of medicine. This article focuses on key neurologic presentations of respiratory and metabolic acid-base derangements and potentially life-threatening endocrinopathies. 1Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. DOI: 10.1016/j.ncl.2009.09.002 Alan H Yee 1Alejandro A RabinsteinA

Respiratory Acidosis and Respiratory Alkalosis and Minute Ventilation

Respiratory Acidosis : is Pco2> 40 mm Hg (hypercapnia). Cause is

Decrease in minute ventilation (hypoventilation)

Respiratory Alkalosis : is Pco2< 38 mm Hg (hypocapnia). Cause is

Increase in minute ventilation (hyperventilation)

Neither will show up on blood panels and both can cause cognitive dysfunction and confused states [hypo-motor, hyper-motor and mixed.]

Minute Ventilation is easy to measure.

You need to know the respiratory rate per minute [measure with a stop watch for one minute] AND you need the tidal volume at rest [measure with a handheld spirometer ].


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