In respiratory acidosis, which statement accurately describes the acid–base status and management?

In respiratory acidosis, which statement accurately describes the acid–base status and management?

• A. pH < 7.35 with pCO2 > 40; causes include hypoventilation; requires intubation or BiPAP
• B. pH > 7.45 with pCO2 < 40; diuresis is indicated
• C. pH < 7.35 with pCO2 < 40; treat with bicarbonate
• D. pH > 7.45 with pCO2 > 40; manage with diuretics

Answer: (B)

Respiratory acidosis happens when ventilation is reduced, so CO2 builds up in the blood. That increased CO2 shifts the carbonic acid balance toward more H+, lowering the pH. The body can compensate over time by the kidneys retaining bicarbonate, but this takes days. The key management is to improve ventilation right away—use noninvasive ventilation (BiPAP) if possible, or endotracheal intubation with mechanical ventilation for more severe cases, and address the underlying cause of hypoventilation. Diuresis is not part of correcting respiratory acidosis, and bicarbonate therapy isn’t routinely given for this condition (except in rare, extreme scenarios). The pattern that fits respiratory acidosis is a lowered pH with an elevated CO2 due to hypoventilation, with a plan focused on restoring ventilation.

Respiratory acidosis happens when ventilation is reduced, so CO2 builds up in the blood. That increased CO2 shifts the carbonic acid balance toward more H+, lowering the pH. The body can compensate over time by the kidneys retaining bicarbonate, but this takes days. The key management is to improve ventilation right away—use noninvasive ventilation (BiPAP) if possible, or endotracheal intubation with mechanical ventilation for more severe cases, and address the underlying cause of hypoventilation. Diuresis is not part of correcting respiratory acidosis, and bicarbonate therapy isn’t routinely given for this condition (except in rare, extreme scenarios). The pattern that fits respiratory acidosis is a lowered pH with an elevated CO2 due to hypoventilation, with a plan focused on restoring ventilation.