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09-SEPTEMBER-2008 02:07:44 - Hypercapnia Hypercapnia Classification and external resources Carbon dioxide ICD-10 R06.8 ICD-9 786.09 DiseasesDB 95 MeSH D006935 Hypercapnia or hypercapnea from the Greek hyper = above and kapnos = smoke, also known as hypercarbia, is a condition where there is too much carbon dioxide CO2 in the blood. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs. Hypercapnia is the opposite of hypocapnia. Contents 1 Causes 2 Symptoms 3 Laboratory Values 4 During diving 4.1 Additional Sources of CO2 in diving 4.2 Skip breathing 4.3 Rebreathers 5 See also 6 References Causes Hypercapnia is generally caused by hypoventilation, lung disease, or diminished consciousness. It may also be caused by exposure to environments containing abnormally high concentrations of carbon dioxide usually due to volcanic or geothermal causes, or by rebreathing exhaled carbon dioxide. It can also be an initial effect of administering supplemental oxygen on a patient with sleep apnea. In this situation the hypercapnia can also be accompanied by respiratory acidosis. 1 Symptoms Symptoms of early hypercapnia, where arterial carbon dioxide pressure, PaCO2, is elevated but not extremely so, include flushed skin, full pulse, extrasystoles, muscle twitches, hand flaps, reduced neural activity, and possibly a raised blood pressure. In severe hypercapnia generally PaCO2 greater than 100 hPa or 75 mmHg, symptomatology progresses to disorientation, panic, hyperventilation, convulsions, unconsciousness, and eventually death.23 Laboratory Values Hypercapnia is generally defined as a blood gas carbon dioxide level over 45 mmHg. Since carbon dioxide is in equilibrium with bicarbonate in the blood, hypercapnia can also result in a high serum bicarbonate HCO3- concentration. Normal bicarbonate concentrations vary from 22 to 28 milligrams per deciliter. During diving Normal respiration in divers results in alveolar hypoventilation resulting in inadequate CO2 elimination or hypercapnia. Lanphier's work at the US Naval Experimental Diving Unit answered the question why don't divers breathe enough?:4 Higher Inspired Oxygen PiO2 at 4 ata 404 kPa accounted for not more than 25% of the elevation in End Tidal CO2 etCO2 above values found at the same work rate when breathing air just below the surface.5678 Increased Work of Breathing accounted for most of the elevation of PACO2 alveolar gas equation in exposures above 1 ata 101 kPa, as indicated by the results when helium was substituted for nitrogen at 4 ata 404 kPa.5678 Inadequate ventilatory response to exertion was indicated by the fact that, despite resting values in the normal range, PetCO2 rose markedly with exertion even when the divers breathed air at a depth of only a few feet.5678 Additional Sources of CO2 in diving There are a variety of reasons for carbon dioxide not being expelled completely when the diver exhales: The diver is exhaling into a vessel that does not allow all the CO2 to escape to the environment, such as a long snorkel, full face diving mask, or diving helmet. The diver then re-inhales from that vessel Increased deadspace.8 The carbon dioxide scrubber in the diver's rebreather is failing to remove sufficient carbon dioxide from the loop Higher inspired CO2. The diver is over-exercising, producing excess carbon dioxide due to elevated metabolic activity. The density of the breathing gas is higher at depth, so the effort required to fully inhale and exhale has increased, making breathing more difficult and less efficient Work of breathing.4 The higher gas density also causes gas mixing within the lung to be less efficient, thus increasing the deadspace wasted breathing.8 The diver is deliberately hypoventilating, known as skip breathing see below. Skip breathing Skip breathing is a controversial technique to conserve breathing gas when using open-circuit scuba, which consists of briefly holding one's breath between inhalation and exhalation i.e. skipping a breath. It leads to CO2 not being exhaled efficiently. There is also an increased risk of burst lung from holding the breath while ascending. Skip breathing is counter productive with a rebreather where the act of breathing pumps the gas around the loop pushing carbon dioxide through the scrubber and mixing freshly injected oxygen. Rebreathers In closed circuit SCUBA rebreather diving, exhaled carbon dioxide must be removed from the breathing system, usually by a scrubber containing a solid chemical compound with a high affinity for CO2, such as soda lime. If not removed from the system, it may be re-inhaled, causing an increase in the inhaled concentration. See also Permissive hypercapnia hypocapnia, decreased level of carbon dioxide Respiratory Physiology Ocean acidification References ^ Dement, Roth, Kryger, 'Principles Practices of Sleep Medicine' 3rd ion, 2000, pg.887 ^ Lambertsen, C. J. 1971. Carbon Dioxide Tolerance and Toxicity. Environmental Biomedical Stress Data Center, Institute for Environmental Medicine, University of Pennsylvania Medical Center IFEM Report No. 2-71. Retrieved on 2008-06-10. ^ Glatte Jr H. A., Motsay G. J., Welch B. E. 1967. Carbon Dioxide Tolerance Studies. Brooks AFB, TX School of Aerospace Medicine Technical Report SAM-TR-67-77. Retrieved on 2008-06-10. ^ a b 2006 US Navy Diving Manual, 6th revision. United States: US Naval Sea Systems Command. Retrieved on 2008-06-10. ^ a b c Lanphier, EH 1955. Nitrogen-Oxygen Mixture Physiology, Phases 1 and 2. US Naval Experimental Diving Unit Technical Report AD0784151. Retrieved on 2008-06-10. ^ a b c Lanphier EH, Lambertsen CJ, Funderburk LR 1956. Nitrogen-Oxygen Mixture Physiology - Phase 3. End-Tidal Gas Sampling System. Carbon Dioxide Regulation in Divers. Carbon Dioxide Sensitivity Tests. US Naval Experimental Diving Unit Technical Report AD0728247. Retrieved on 2008-06-10. ^ a b c Lanphier EH 1958. Nitrogen-oxygen mixture physiology. Phase 4. Carbon Dioxide sensitivity as a potential means of personnel selection. Phase 6. Carbon Dioxide regulation under diving conditions. US Naval Experimental Diving Unit Technical Report AD0206734. Retrieved on 2008-06-10. ^ a b c d e Lanphier EH 1956. Nitrogen-Oxygen Mixture Physiology. Phase 5. Added Respiratory Dead Space Value in Personnel Selection tests Physiological Effects Under Diving Conditions. US Naval Experimental Diving Unit Technical Report AD0725851. Retrieved on 2008-06-10. v d e Symptoms and signs: circulatory and respiratory systems R00-R09, 785-786 Cardiovascular system heartbeat: Tachycardia - Bradycardia - Palpitation blood flow: Heart murmur - Bruit/Carotid bruit - Epistaxis Gangrene Respiratory system and other chest symptoms Hemoptysis - Cough abnormalities of breathing Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Rales - Hypercapnia Retrieved from http://en..org/wiki/Hypercapnia Categories: Diving medicine | Pulmonology | Medical emergencies Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Bosanski Deutsch Español Esperanto Français Italiano ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий СрпÑ?ки / Srpski Svenska This page was last modified on 11 July 2008, at 23:51
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