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Respiratory acidosis occurs when the arterial partial pressure of carbon dioxide (Pa CO2) is elevated above the normal range (>44 mm Hg) leading to a blood pH lower than 7.35.By definition, the diagnosis of respiratory acidosis requires measurement of Pa CO2 and pH. When the diagnosis is made, the underlying cause should be thoroughly investigated.
In the acute state, respiratory compensation of acidosis occurs by hyperventilation resulting in a relative reduction in PaCO2. Chronically, renal compensation occurs by means of reabsorption of HCO3. Acidosis arises from an increased production of acids, a loss of alkali, or a decreased renal excretion of acids. The underlying etiology of metabolic acidosis is classically categorized into those that cause an elevated anion gap (AG) (see the Anion Gap calculator) and those that do not.