The respiratory response to hypercapnia is to increase respiratory rate. Paula cannot do this. She cannot increase her respiratory rate during a respiratory crisis. Plus, her respiratory rate is very slow at rest when awake.
No one measures respiratory rate outside the ICU so no one knows that Paula has impaired metabolic flexibility.
Acidosis is caused by an overproduction of acid that builds up in the blood or an excessive loss of bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood that results from poor lung function or depressed breathing (respiratory acidosis). Acidosis By James L. Lewis, III , MD, Brookwood Baptist Health and Saint Vincent’s Ascension Health, BirminghamLast full review/revision Jan 2020| Content last modified Jan 2020 https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/acidosis
Paula has naturally depressed breathing or bradypnea BUT can be completely healthy despite her depressed breathing.
It seems that scientists and doctors do not know very much about conditions such as hers.
If her lung function declines due to illness, infection or exposure, then the depressed breathing becomes a bigger problem, causing mood [anguish, distress] , increased ICP [most likely] and altered mental status and more.
Most of what we know about acid base of the blood and its effects come from patients in Intensive Care Unit beds.
We know nothing about acid base in patients with naturally depressed breathing who remain ambulatory.
And remaining ambulatory, if you can, is very helpful to lung function and to breathing and to fighting respiratory acidosis.