Clinical Signs of Hypercapnia are mostly Nonspecific and Psychiatric

 HYPERCAPNIA Clinical Significance: Patients with hypercapnia can present with tachycardia, dyspnea, flushed skin, confusion, headaches, and dizziness. If the hypercapnia develops gradually over time, symptoms may be mild or may not be present at all. Other cases of hypercapnia may be more severe and lead to respiratory failure. In these cases, symptoms such as seizures, papilledema, depression, and muscle twitches can be seen. If a patient presents with signs and symptoms of hypercapnia, immediate medical attention should be considered before CO2 reaches life-threatening levels.[10][11]

A very very easy non invasive prognostic signs would be to obtain a minute volume. How to do so was explained in the previous blog.

Hypercapnia should be managed by addressing its underlying cause. In order to figure out the underlying issue, an arterial blood gas test will most likely be necessary. It is invasive and painful, but missing serious cases of HYPERCAPNIA should be actionable, in my view. Undiagnosed exacerbated attacks of already chronic hypercapnia can ruin someone’s life. In bipolar illness, the problem seems to be abnormal breathing rates, speeds and abnormal responses to rising CO2….. [CO2 is normally but not always a respiratory stimulus, especially if there is peripheral nervous system damage preventing a normal response at rest.]

In this blog we have discussed how Paula;s brain seem to track for oxygen, ignoring PCO2, her PCO2 hypothetically being most likely chronically abnormal. This is obvious from her breathing rate at rest-which is way to low, and from her minute volume which is 1950 ml/ minute at rest instead of 6000 ml/minute at rest. This is an important clue that every doctor she has seen has missed and if they were told about they ignored it. Psychiatric signs and symptoms suggesting hypercapnia respiratory failure is not taught in medical school, except as signs of a so called mental illness. Measuring respiratory rate at rest is an easy way to catch approaching respiratory failure. Measuring respiratory rates at rest used to be taught to ordinary people in first aid classes. But doctors? NEVER NEVER NEVER. How arrogant is that?

HYPERCAPNIA: Treatments: A noninvasive positive pressure ventilator may provide support to patients who are having trouble breathing normally. If a noninvasive ventilator is not efficient, intubation may be indicated. Bronchodilators may also be used in patients suffering from an obstructive airway disease.

In recent studies, the use of the esophageal balloon in managing hypercapnia in a patient with acute respiratory distress syndrome was also shown to be effective. https://www.ncbi.nlm.nih.gov/books/NBK482456/ StatPearls [Internet]. Physiology, Carbon Dioxide Retention Shivani Patel; Julia H. Miao; Ekrem Yetiskul; Sapan H. Majmundar.

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