Hypercapnia is a cause of disturbances to mood and mind.
Hypercapnia refers to being exposed to air that has higher than normal levels of carbon dioxide. This can occur in a poorly ventilated place, an overcrowded place, a place which uses caustic chemicals, a place where agricultural chemicals are used, and a place near commercial livestock industry. Paula worked for 15 years in just such a place. The poor ventilation was exacerbated in the later years when windows were kept closed, in order to save on energy despite the very poor ventilation and the overpopulation problems.
So Paula was definitely exposed to many chemicals and most likely to higher levels of carbon dioxide in the workplace and also to mould [the building was over a century old and a lot of construction was done by contractors with little experience regarding renovating heritage buildings; many mistakes were made].
Hypercapnia or higher levels of PCO2 can also occur if the lungs are damaged or if one has a depressed respiratory rate or minute ventilation and does not exhale very often. Paula’s lungs were in fine form, very healthy. But she did have a depressed respiratory rate and she did not exhale very often, far less often than is normal. She had difficulty exhaling and needed to utilize abdominal muscles in order to squeeze air out of her normal lungs. Paula did not know that she had a depressed respiratory rate or active exhaling at the time. No one did.
Depressed respiratory rate is a cause of hypercapnia which is a cause of disturbance of mood and mind.
Interestingly, Paula was fine for years, until she suddenly woke up [after a bunch of non specific illnesses, a cold, stomach flu, nothing more] with disturbance of mind and did not know it. She became mentally confused, mostly silent [no strength to speak], internally stiff, and intellectually slow. And she did not know it. She also felt terrible, full of continual fear and had no idea what was wrong.
If we work backwards and look at the physical signs of hypercapnia and/or respiratory acidosis, we will see that that these match Paula’s physical signs during her disturbance of mind and mood and locomotor activity. The physical signs also matched the signs found by Dr Emile Kraepelin over a century ago, in thousands of patients with the same disturbances in mind, mood and locomotor activity as Paula.
Kraepelin hypothesized that hypercapnia was the most likely reason for thousands of patients’ disturbance of mind and mood. Because he measured their vital signs and so it was obvious.
Hypercapnia will disturb normal chemical balance of the blood. The pulmonary ventilatory systems [the motor part of moving air in and out of the body] and the renal systems are supposed to compensate for changes to the pH of the blood due to exposure in the air and/or due to illness affecting breathing. Unless they can’t. Unless they have been damaged.
Then pH, and PCO2 and possibly PO2 will be affected; and chronically abnormal levels of these cause mental confusion. That is what Paula and Kraepelin’s patients experienced. The unpleasantness they experienced and the very high distress and fear is also caused by respiratory acid base disorder.
Paula cannot exhale more or faster when hypercapnic, and she will continue to have disturbance of mind until she can clear the CO2 in the blood.
Paula and the Kraepelin patients all had pulmonary ventilatory depression, with distressed/upset/fearful mood, depressed levels of voluntary speech, and voluntary locomotor activity.
As is reported in hypercapnia all had raised blood pressure, raise heart rate, heart signs [arrhythmia’s, dullness, etc..] but temperature was depressed- like breathing rate, cognition, voluntary speech and locomotion [[temperature was mildly hypothermic.
Circulation was affected and feet and hands and lips were pale, cold, even blue- signs of vasoconstriction- to stem bleeding or in response to mild hypothermia or both].
Hypercapnia, respiratory acidosis with normal lung function, lack of reflex ability to compensate by breathing faster at rest, will result in disturbance of mind, mood and locomotor activity and will activate specific reflex responses to try to restore the chemical balance of the blood, especially PCO2-which the brain follows very closely.
Physically examining the patient with disturbance of mind and mood carefully and getting their baseline at rest, respiratory rate, blood pressure, heart rate [and heart signs] and temperature will alert you of pulmonary ventilatory defects making chemical balance of the blood difficult.
to be continued……..
Of Sound Mind 