All right, so welcome back to the Internet Book of Critical Care podcast. I'm here with Adam

Thomas, and we're going to talk about respiratory acidosis, aka hypercafnea. How have we not done this yet,

Josh? Like, we were going through the list of things we got to do, and this is fun. Like,

we get to do a basics one for a while that we haven't got to do,

hey? I don't know. I have mixed feelings about this. I'm worried that it will inspire people to

check more blood gases, which will lead to more ICU consults and more calls. So I, I don't know.

Josh, the CO2 is 90. But what is the pH? No, no, it's the CO2 is like 45 and we just gave them like a pillow percissette and this sky's gonna fall down.

Oh, that's even worse.

Okay, so the whole point of this is to prevent that, right Josh?

So we're gonna map out a wonderful approach to respiratory acidosis here. And we'll talk about the usual

symptoms labs. But more importantly, the approach of can't breathe, won't breathe, and breathing

isn't working, which I really like this approach, Josh, and I think we need to really center on it.

So let's get straight into this, respiratory acidosis. The point here is that compensated or not compensated,

but you tell me if it is clinically impacting the patient, what did they present with?

And just to take a quick step back, talking about respiratory acidosis and hypercapnia

is super challenging because it can be caused by a lot of different things and really like the

management and the interpretation depends very heavily on the context. So we're going to try to do this

justice, but it's really difficult because everything is very contextual. For example,

symptoms are going to vary hugely depending on context. So if you have someone who's chronically

hypercafnic, for example, due to COPD, they may have a very weak or kind of suppressed respiratory drive, so they can kind of slip into this hypercaptic state

where the hypercafni is causing somnolence, delirium, kind of myoclonus, asterixus, altered mental status,

you know, and what we kind of think about with hypercaptych respiratory failure, like your COPD, hypercaptic person who's just not breathing. On the flip side, if someone with a normal respiratory center, normal respiratory drive suddenly

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