Respiratory acidosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Differentiating Respiratory acidosis from other Diseases

Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); DOE (dyspnea on exercise); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchitis[1] - - - + + + - - - - - - Rhonchi  WBC Respiratory acidosis Normal Normal Physical exam Rhonchi relieved by cough
Rib fractures (flail chest)[2] - + - - + - - - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Central nervous system Traumatic brain injury[3] + +/- - - - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Toxic/Metabolic Organophosphate poisoning[4] + - - + - - - - - - - - Wheeze Normal O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Carbon monoxide poisoning[5] + - - - + + - - + - - - Wheeze Carboxyhemoglobin Respiratory acidosis Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Systemic Pregnancy[6] - - - - +/- - - - - - - + Normal WBC, RBC O2, ↑CO2 Normal Vt, ↑RV βhCG Missed period, Hyperemesis
Sepsis[7] +/- - - + - - - - - - - - Normal WBC, neutrophilia O2, ↑CO2 Normal Normal SIRS criteria Chills, Confusion
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Orthopnea DOE Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchial asthma[8] - + +/- - +/- + - - + + - - Wheeze Eosinophil Respiratory acidosis Pulmonary hyperinflation,

Bronchial wall thickening

FEV1/FVC Spirometry before and after bronchodilator Paroxysmal respiratory distress
COPD[9] - - +/- - - + + + + + + +/- Expiratory wheeze RBC Respiratory acidosis ↑ Bronchovascular markings, Cardiomegaly FEV1/FVC Physical exam and

Spirometry

Heavy smoking history
Emphysema[10] - - - - - +/- - - + + - - Expiratory wheeze, Hyperinflation Normal Respiratory acidosis Flattening of diaphragm, vertical heart FEV1/FVC Physical exam and

Spirometry

Barrel chest
Pulmonary hypertension[11] - - - - +/- +/- - - +/- +/- + + Accentuated S2 Normal Hypoxia and acidosis Enlarged pulmonary arteries Physiologic RV Cardiac catheterization Syncope,

Ascites, Pleural effusion

Interstitial lung disease[12] - - - - + + - - + + - - Rhonchi, Wheezing, Crackles Normal Respiratory acidosis Peripheral pulmonary infiltrative opacification FEV1/FVC High resolution computed tomography (HRCT) Pneumoconiosis
Pulmonary right-to-left shunt[13] - - - - +/- + - - + + - - Diminished breath sounds Normal O2, ↑CO2, Respiratory acidosis Normal Vt, ↑RV

(physiological)

Pulmonary CT angiography Chronic hypoxemia
Diaphragmatic paralysis[14] - - - +/- +/- +/- - - - - - - Normal Normal Respiratory acidosis Unilateral or bilateral diaphragmatic flattening Vt, ↑RV

(anatomical)

CXR confirmed by fluoroscopic sniff test Respiratory insufficiency
Systemic Obesity[15] - - - - - - - - - - - - Normal Normal Respiratory acidosis Normal Vt, ↑RV

(anatomical)

BMI Low stamina,

Sweating

References

  1. Cantin, Luce; Bankier, Alexander A.; Eisenberg, Ronald L. (2009). "Bronchiectasis". American Journal of Roentgenology. 193 (3): W158–W171. doi:10.2214/AJR.09.3053. ISSN 0361-803X.
  2. Swart E, Laratta J, Slobogean G, Mehta S (February 2017). "Operative Treatment of Rib Fractures in Flail Chest Injuries: A Meta-analysis and Cost-Effectiveness Analysis". J Orthop Trauma. 31 (2): 64–70. doi:10.1097/BOT.0000000000000750. PMID 27984449.
  3. McAllister TW (2011). "Neurobiological consequences of traumatic brain injury". Dialogues Clin Neurosci. 13 (3): 287–300. PMC 3182015. PMID 22033563.
  4. Peter JV, Sudarsan TI, Moran JL (2014). "Clinical features of organophosphate poisoning: A review of different classification systems and approaches". Indian J Crit Care Med. 18 (11): 735–45. doi:10.4103/0972-5229.144017. PMC 4238091. PMID 25425841.
  5. Lane TR, Williamson WJ, Brostoff JM (2008). "Carbon monoxide poisoning in a patient with carbon dioxide retention: a therapeutic challenge". Cases J. 1 (1): 102. doi:10.1186/1757-1626-1-102. PMC 2533003. PMID 18710551.
  6. Lee SY, Chien DK, Huang CH, Shih SC, Lee WC, Chang WH (August 2017). "Dyspnea in pregnancy". Taiwan J Obstet Gynecol. 56 (4): 432–436. doi:10.1016/j.tjog.2017.04.035. PMID 28805596.
  7. Askim Å, Mehl A, Paulsen J, DeWan AT, Vestrheim DF, Åsvold BO; et al. (2016). "Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993-2011: an observational study". BMC Infect Dis. 16: 223. doi:10.1186/s12879-016-1553-8. PMC 4877975. PMID 27216810.
  8. Hodder R, Lougheed MD, Rowe BH, FitzGerald JM, Kaplan AG, McIvor RA (2010). "Management of acute asthma in adults in the emergency department: nonventilatory management". CMAJ. 182 (2): E55–67. doi:10.1503/cmaj.080072. PMC 2817338. PMID 19858243.
  9. Qureshi H, Sharafkhaneh A, Hanania NA (2014). "Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications". Ther Adv Chronic Dis. 5 (5): 212–27. doi:10.1177/2040622314532862. PMC 4131503. PMID 25177479.
  10. Sharafkhaneh A, Hanania NA, Kim V (2008). "Pathogenesis of emphysema: from the bench to the bedside". Proc Am Thorac Soc. 5 (4): 475–7. doi:10.1513/pats.200708-126ET. PMC 2645322. PMID 18453358.
  11. Sajkov D, Petrovsky N, Palange P (June 2010). "Management of dyspnea in advanced pulmonary arterial hypertension". Curr Opin Support Palliat Care. 4 (2): 76–84. doi:10.1097/SPC.0b013e328338c1e0. PMID 20407377.
  12. Baughman RP, Shipley RT, Loudon RG, Lower EE (1991). "Crackles in interstitial lung disease. Comparison of sarcoidosis and fibrosing alveolitis". Chest. 100 (1): 96–101. PMID 2060395.
  13. Vodoz JF, Cottin V, Glérant JC, Derumeaux G, Khouatra C, Blanchet AS; et al. (2009). "Right-to-left shunt with hypoxemia in pulmonary hypertension". BMC Cardiovasc Disord. 9: 15. doi:10.1186/1471-2261-9-15. PMC 2671488. PMID 19335916.
  14. Dubé BP, Dres M (2016). "Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies". J Clin Med. 5 (12). doi:10.3390/jcm5120113. PMC 5184786. PMID 27929389.
  15. Sin DD, Jones RL, Man SF (July 2002). "Obesity is a risk factor for dyspnea but not for airflow obstruction". Arch. Intern. Med. 162 (13): 1477–81. PMID 12090884.

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