Which factors may predispose the patient to respiratory acidosis? Select all that apply.

Nasogastric suctioning

Overdose of sedatives

Central nervous system depression

Diabetic ketoacidosis

Anxiety and fear

Answer and Explanation

Correct Answer : B,C

Rationale:

A. Nasogastric suctioning removes gastric contents, including hydrochloric acid. This loss of acid can lead to metabolic alkalosis, not respiratory acidosis, because it affects the bicarbonate-to-acid balance in the blood. It does not interfere with CO2 retention or the respiratory process, so it does not directly cause respiratory acidosis.

B. Sedatives, including benzodiazepines, barbiturates, or opioids, can depress the central respiratory center in the brainstem. When the respiratory drive is suppressed, the patient breathes more slowly or shallowly, resulting in hypoventilation. Hypoventilation leads to CO2 retention, which combines with water to form carbonic acid, lowering blood pH and causing respiratory acidosis. This is a common scenario in overdose situations, particularly in older adults or patients with pre-existing lung disease.

C. CNS depression can result from head trauma, stroke, tumors, or other neurologic disorders that impair the brain’s ability to regulate breathing. Like sedative overdose, CNS depression reduces respiratory drive, leading to inadequate alveolar ventilation, CO2 accumulation, and respiratory acidosis. This is why monitoring respiratory rate, depth, and ABGs is critical in patients with CNS compromise.

D. Diabetic ketoacidosis (DKA) causes metabolic acidosis due to the accumulation of ketone bodies, not respiratory acidosis. Patients with DKA usually hyperventilate (Kussmaul respirations) as a compensatory mechanism to blow off CO2 and partially correct the acidosis. Therefore, DKA predisposes to metabolic, not respiratory, acid-base disturbances.

E. Anxiety and fear typically lead to hyperventilation, in which the patient breathes rapidly and deeply. This causes excessive CO2 elimination, lowering PaCO2 and resulting in respiratory alkalosis, the opposite of respiratory acidosis.

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Correct Answer is B

Explanation

Rationale:

A. PaCO2 represents the partial pressure of carbon dioxide in arterial blood and reflects the respiratory component of acid-base balance. In metabolic acidosis, the primary problem is low bicarbonate (HCO3-). The body often compensates with hyperventilation (Kussmaul respirations) to blow off CO2, which lowers PaCO2, not increases it. A PaCO2 above 45 mm Hg would indicate hypoventilation and could worsen acidosis.

B. Metabolic acidosis is characterized by a decrease in blood pH (<7.35) due to excess acid accumulation (e.g., lactic acidosis, ketoacidosis, renal failure) or loss of bicarbonate (e.g., diarrhea). The low pH is the hallmark finding in metabolic acidosis and confirms the acidic state of the blood.

C. PaO2 indicates the oxygen level in arterial blood. Metabolic acidosis does not directly affect oxygenation, so a PaO2 below 70 mm Hg is not a defining feature of metabolic acidosis. Low PaO2 may occur in respiratory or hypoxic conditions, but it is not specific to metabolic acidosis.

D. HCO3 (bicarbonate) is low (<22 mEq/L) in metabolic acidosis because the body has either lost bicarbonate or accumulated acids that consume bicarbonate. An HCO3 above 26 mEq/L would indicate metabolic alkalosis or compensation for chronic respiratory acidosis, not metabolic acidosis.

A. Decrease in cardiac output B. Hypovolemic shock C. Increase in venous return D. Neurogenic shock

Correct Answer is A

Explanation

Rationale:
A. Decrease in cardiac output is correct. Positive end-expiratory pressure (PEEP) increases intrathoracic pressure, which can reduce venous return to the heart, thereby decreasing preload. Reduced preload lowers stroke volume and cardiac output, resulting in hypotension. This is a well-recognized hemodynamic effect of PEEP, especially in patients who are hypovolemic or have borderline cardiac function.

B. Hypovolemic shock is incorrect. While hypovolemia can cause hypotension, the sudden drop in blood pressure immediately after PEEP initiation points to a mechanical effect on cardiac output rather than ongoing fluid loss.

C. Increase in venous return is incorrect. PEEP actually reduces venous return due to increased intrathoracic pressure, so an increase in venous return would tend to raise blood pressure, not decrease it.

D. Neurogenic shock is incorrect. Neurogenic shock results from loss of sympathetic tone after spinal cord injury, causing hypotension and bradycardia. This patient’s hypotension occurred immediately after PEEP initiation, which is a mechanical effect, not a neurogenic event.

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Which factors may predispose the patient to respiratory acidosis? Select all that apply.

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