A 75-year-old man develops acute confusion and drowsiness after a dental procedure. He has a history of severe chronic lung disease due to smoking. Earlier in the day, he had a tooth extraction and afterwards was given acetaminophen with codeine (Tylenol 3) for pain relief.For the above patient with new symptoms, select the most likely acid base disorder.
High-Yield Explanation
Causes of acute respiratory acidosis include narcotic overdose, myasthenia gravis, airway obstruction, and trauma to the chest. Acute increases in PaCO2 result in carbon dioxide narcosis. This starts with somnolence and confusion and can lead to coma. Asterixis may be present. Cerebral vasodilation may result in frank papilledema.