in an ambulatory person? I do not think anyone knows. I do not think that this has been studied. Kraepelin also described patients with bipolar illness to be in semi stuporous states. Could major depression be a state of respiratory acidosis bringing about a semi stuporous state?
“Respiratory acidosis can be acute or chronic; the chronic form is asymptomatic, but the acute, or worsening, form causes headache, confusion, and drowsiness. Signs include tremor, myoclonic jerks, and asterixis. Diagnosis is clinical and with arterial blood gas and serum electrolyte measurements.” Respiratory Acidosis – Endocrine and Metabolic Disorders …https://www.merckmanuals.com/en-ca/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/respiratory-acidosis
Do you know a single patient who comes into hospital with headache, confusion and drowsiness, and gets worked up for Respiratory Acidosis ?
Or do they get a psychiatric consult instead?
And does the patient get their breathing rate and depth evaluated to see if they possibly have a high PaCO2?
Paula got nothing. She was sent for a psychiatric consult. She got psychotherapy. No doctor counted her breathing rate at rest. No one sent her for a test to get her tidal volume at rest. Now we know her results.
RESULTS; Minute Ventilation -to be continued!!!!!!!!
It is obvious that she must be at greater risk than many for an attack of respiratory acidosis, yet no one even knows of her respiratory defect. [including her-unless she counts her RR at rest-it is always only 3 and it goes up to 6 or 8 with exercise and with breathing difficulty from upper respiratory obstruction, RR goes down to 2.5]. Surely this is a part of what needs to be investigated in attacks that alter her consciousness [sympathetic activation and increased arousal] plus dulling of intellect [reversible].
She does not exchange 6-8 L of air per minute,in health and in illness, and when she looks like she is in a depressed state and is not able to function; consideration of the “Clinical” syndrome of respiratory acidosis should be considered and should be worked up and should be treated or at least, future treatments for patients with this respiratory defect, should be developed.
This would need to be studied.
to be continued….