What is hypercapnia?Symptoms of mild hypercapnia include redness, headache, obvious blood vessels, muscle twitching, increased heart rate, and mild confusion.
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Under hypercapnia, the medicine understands a high CO2 content in the (arterial) blood. In healthy people, the arterial partial pressure is a maximum of 40 mmHg. Patients with hypercapnia have a value of over 45 mmHg. Hypercapnia distinguishes between an acute and a chronic form.
If, for some reason, a person can not exhale the carbon dioxide produced or inhaled as a metabolite by-product, it will be enriched in the blood. Then the CO2 partial pressure rises in the alveoli. The greater the acidification (acidosis) of the blood with the gas, the more the respiratory activity of the lungs is hindered.
It comes to respiratory insufficiency (shortness of breath). Hypercapnia may also be a symptom of another condition, such as Pickwick's syndrome in patients with high levels of obesity. If the respiratory insufficiency is not treated in time, serious damage to the brain and heart occurs. In the worst case, CO2 narcosis with consequent death by respiratory arrest occurs.
Hypercapnia can have different causes. Due to adverse circumstances (accident), for example, it comes to the inhalation of extremely CO2-containing air. CO2 rebreathing, such as sudden infant death syndrome (SID), can also cause hypercapnia. Metabolic alkalosis, caused by acute potassium deficiency, can also lead to the appearance of excessive CO2 accumulation in the blood.
Inadequate respiratory function (respiratory insufficiency) due to damage to the alveoli (crushing of the chest due to an accident) or an obstruction in the respiratory tract are also responsible for the occurrence of hyperacidity of the blood with CO2. Other triggers include: damage to the respiratory center in the brain by a cerebral infarction, impairment of the nerve tracts to the chest muscles by a paraplegia, pulmonary embolism, lung tumor, severe asthma attacks, shortness of breath due to severe cold, severe pulmonary emphysema or even pneumonia.
Also, septic shock, certain neuromuscular disorders, ingestion of an inappropriate drug (steroids, dehydrating medications, tranquilizers, anesthetics) and accidental administration of oxygen in patients with chronic obstructive pulmonary disease (COPD).
They have a strong hyperacidity of the blood because of the permanent overloading of their respiratory tract anyway. The latter, however, requires the activation of the respiratory reflex. If oxygen is then inadvertently introduced, respiratory stimulation is inhibited and, in the worst case, respiratory arrest.
Symptoms, complaints & signs
Symptoms of mild hypercapnia include redness, headache, obvious blood vessels, muscle twitching, increased heart rate, and mild confusion. With increasing partial CO2 pressure, tremors (tremor), increased breathing as an attempt to compensate for shortness of breath, increased blood pressure and dizziness.
If the affected person then receives no help and the partial pressure rises to over 50 mmHg, seizures, sweating, heart-turf, panic and hypoxia (undersupply of the body with oxygen) occur. The heartbeat slows down, the blood pressure drops sharply. This is followed by disturbances of consciousness with increasing drowsiness. The patient falls into a coma (CO2 narcosis). If there is no ventilation at this stage of hypercapnia, his lips turn blue (cyanosis) and death from respiratory arrest occurs.
Diagnosis & disease course
Hypercapnia can be detected by arterial blood gas analysis. It also measures the pH and oxygen saturation of the blood. If the pH falls below 7.35, respiratory acidosis is present. Acidification of the blood leads to a constriction of the blood vessels in the lungs, while at the same time enlarging those of the brain and the rest of the body. As a result, there is an increased potassium concentration in the blood, which affects the heart function and can lead to cardiac arrhythmia. From a partial pressure of more than 60 mmHg the patient falls into a coma.
Without treatment, hypercapnia can, in the worst case, lead to the death of the patient. The affected person usually dies of anesthesia due to carbon dioxide, because the blood is extremely acidified. Finally, it comes to respiratory arrest and thus to cardiac arrest. In acute emergencies, therefore, an urgent treatment by a doctor is necessary.
Furthermore, the sufferer suffers from a high heart rate and a versedness. Likewise, headaches occur and the patient's skin is usually reddened. The muscles twitch involuntarily and comes to a tremor. The quality of life is extremely reduced by the hypercapnia and the sufferer also suffers from dizziness and nausea.
Not infrequently, there is also a loss of consciousness, in which the patient can incur injuries through a fall. Most sufferers also show a panic attack when the symptoms of hypercapnia occur. The treatment of the disease takes place in any case acute and must keep the person alive.
Furthermore, the underlying disease must also be treated. Whether further complications occur with this treatment depends strongly on the underlying disease and can not generally be predicted universally. In most cases, the life expectancy is reduced by the hypercapnia.
When should you go to the doctor?
Symptoms such as redness, headache, and muscle twitching may be due to hypercapnia. A doctor should be consulted if these symptoms occur for no apparent reason and persist for more than three to four days. If additional symptoms occur, such as an increased heart rate or confusion, you must go to the doctor the same day.
If the hypercapnia remains untreated, convulsions, tachycardia and sweats set in - at the latest then medical advice is needed. With increasing disturbances of consciousness, the rescue service must be alerted. External signs such as a blue color of the lips, usually associated with a circulatory collapse, require immediate first aid measures. Afterwards, the person concerned must be provided with an emergency medical treatment or taken to a hospital. Hypercapnia is often associated with potassium deficiency, severe colds or pneumonia.
A septic shock and the use of certain medications may be the cause. If the symptoms listed above are related to these conditions and risk factors, consult a doctor immediately. In addition to the family doctor, a pulmonologist or a specialist in internal medicine is the right contact person.
Therapy & Treatment
The emergency medical first treatment is to take the impotent patient out of tight clothing and store his chest higher. The legs should be lowered. Then the oxygen mask is put on. Liquid should be used sparingly, if at all. In the intensive care unit, the treatment of his underlying disease can then take place in addition to the further ventilation of the patient. He is being ventilated by intubation or by an oxygen mask.
He is connected to the BIPAP (Biphasic Positive Airway Pressure). The innovative ventilator allows the awakening patient to breathe at both the lower and upper pressure levels. This stimulates the diaphragmatic activity, which in turn initiates activation of the breathing pump. With stronger breaths, the upper pressure level is lowered until both pressure levels correspond to each other. Then the extinction of the hypercapnia patient takes place.
In chronic ventilatory insufficiency ventilation of the patient is difficult because he is usually only a little sedated and the doctors have to wait until self-breath stops. Hypercapnia patients also receive additional beta-sympathomimetics and theophylline. If overdose with tranquilizers or opiates causes blood hyperacidity, Anexate or Naloxone will be administered.
Outlook & Forecast
Hypercapnia has an unfavorable prognosis. In severe cases and without treatment, the disease leads to respiratory arrest and thus to the death of the patient. In the event of an accident or sudden infant death, there is little prospect of timely medical care to ensure the survivor's survival. If a strongly CO²-containing air is inhaled, there is an acute life-threatening condition of the person affected, in which there are hardly any treatment options or the necessary help is too late on site.
If hypercapnia occurs as a result of pronounced obesity or intense pneumonia, there is also little hope of recovery. In most cases, life-prolonging measures are initiated as the underlying disease is already so advanced that recovery can only be documented in very rare cases. Hypercapnia can lead to a loss of consciousness besides the death sequence. This significantly increases the likelihood of sequelae or permanent impairment.
Only with an early treatment of the existing underlying disease as well as the sufficient cooperation of the patient for an improvement of the health, there is a realistic chance for a relief of the complaints. A complete freedom from complaints is rarely given, but in principle quite possible under certain conditions. If irreparable damage to the respiratory function has occurred, it can occur.
To prevent hypercapnia, it is recommended never to abuse steroids, laxatives, opiates, sedatives and other medications. This applies both to the duration of ingestion and to the dosage of the substances. Scuba divers should refrain from sparing breathing. Anyone who suffers from COPD or takes diuretics or steroids, should have his blood levels checked at short intervals. In addition, frequent ventilation of enclosed spaces can help prevent dangerous hypercapnia.
In hypercapnia, the options for aftercare are relatively limited in most cases. They are available to the affected person only after a successful treatment, so that primarily the disease itself must be detected and treated early. The sooner the hypercapnia is detected, the better the general course is.
It can not always come to a complete cure, so that the life expectancy of the patient is limited in many cases by this disease. The affected person must protect his lungs in this disease in any case. Smoking should be avoided. Also, a healthy lifestyle with a healthy diet generally has a positive effect on the course of the disease.
Strong stress on the body or strenuous and physical activities should be avoided. The intake of medication can also have a positive effect on the course of the disease. The affected person must pay attention to a correct dosage with a regular application. Furthermore, the support and care by your own family and by friends is very important to relieve the patient.
You can do that yourself
As a rule, hypercapnia requires immediate treatment by an emergency physician. This can prevent the death of the patient. The complaint itself can be relatively easily prevented by the person concerned not using steroids or laxatives. Other medicines that can cause this disease should not be taken in high amounts. Hypercapnia can also be avoided by regularly ventilating closed spaces, as this will transport fresh and low-carbon air from outside into the room.
Should hypercapnia occur, the emergency physician must be called first and foremost. Until the arrival of the emergency doctor, the clothing of the person concerned should be loosened if it narrows his body. Furthermore, the chest must be high and the legs are stored deep to relieve the discomfort. The administration of liquids should be done only in very small quantities. The further treatment is then carried out by the ambulance with the help of a device for ventilation.
In the course of treatment, it is important for those affected to take the medication. The regular check of the blood values can also prevent possible complications and complaints.