What is Hypercapnia & How is it Treated? | Causes and Symptoms of Hypercapnia

Hypercapnia is a pathological condition characterized by excess of carbon dioxide in the blood. It is generally a result of hyperventilation or breathing disorders where not enough oxygen enters the lungs and very little of carbon dioxide is eliminated. The symptoms of Hypercapnia can be divided into mild and severe.^{[1, 2, 3]}

Medically speaking, a person is said to have Hypercapnia if and when there is an elevation of the partial pressure of carbon dioxide above the standard of 45 mmHg. There are numerous processes and mechanism working in the body that tends to increase the levels of carbon dioxide of which the main process is the pH buffering system between carbon dioxide hydrogen carbonate and carbon dioxide. As a result of this relationship, Hypercapnia causes acid-base imbalance and abnormalities related to it.^[1]

Hypercapnia can be caused due to a variety of reasons. Some of them include:

COPD: This is a collection of disorders that affect the breathing system of a person. Emphysema and bronchitis are some of the most common medical conditions associated with COPD. Bronchitis is caused due to inflammation of the airways. Emphysema involves damage of the alveoli. Both of these conditions are known to cause increased levels of carbon dioxide in the blood resulting in Hypercapnia.^[3]

The most common cause of COPD in adults in the United States is believed to be smoking. Additionally, air pollution also plays a role in the development of COPD in people. It should be noted here that COPD does increase the risk for Hypercapnia but it is not necessary that everybody who has COPD will develop this condition.^[3]

Sleep Apnea: It has been estimated that around 5-20% of people in the United States have problems with their sleep. Sleep apnea is a condition in which a person has pauses while breathing when asleep or has a shallow breathing. Due to this, the balance between oxygen and carbon dioxide is affected and the level of carbon dioxide goes up resulting in possible Hypercapnia.^[3]

Some of the other symptoms associated with sleep apnea include excessive daytime sleepiness, problems with focusing and concentrating on tasks, snoring, and headaches upon awakening.^[3]

Genetic Makeup: At times, Hypercapnia can also be caused due to some genetic abnormality. This is especially in people who have a condition in which the liver fails to produce a specific protein called the alpha-1 antitrypsin. This can cause Hypercapnia. This protein is vital for good lung health of a person and lack of this protein puts the individual at risk for COPD.^[3]

Nerve and Muscle Disorders: At times, the muscles and nerves of a person that are required for adequate functioning of the lungs do not work properly. This may at times result in Hypercapnia. This is seen especially in people with muscular dystrophy in which the muscles become so weak that they are not able to function normally and making it difficult for the person to breathe. Some of the other medical conditions that affect the nerves and muscles and can cause Hypercapnia include ALS, myasthenia gravis, and encephalitis.^[3]

Other Causes: Aside from the reasons mentioned above, there are also certain other causes that can result in Hypercapnia. These include certain activities that affect breathing like deep sea diving. A person with a brainstem stroke also at times can develop Hypercapnia. When there is significant heat loss from the body can also cause Hypercapnia. Overdose of opioids and benzodiazepines can also at times cause Hypercapnia.^[3]

As stated, the symptoms of Hypercapnia can be categorized into mild and severe. There are cases where a person with Hypercapnia has such mild symptoms that he or she may not even realize that they are dealing with this condition. However, it is important to have knowledge of both mild and severe symptoms of Hypercapnia.^[3]

In mild cases of Hypercapnia, the person will complain of dizziness, feeling drowsy, fatigued. The person will feel disoriented and will have problems with breathing. These symptoms are mainly caused due to slow breathing as seen with people who have sleep apnea. These cases however are benign and the body itself balances out the levels of oxygen and carbon dioxide and thus is not a cause for concern.^[3]

In case of severe Hypercapnia, immediate treatment is required to prevent any serious complications. Certain complications of Hypercapnia may even be fatal. A person with severe Hypercapnia will have mental confusion and will be paranoid. They may have hyperventilation as well. Sometimes, they also have arrhythmia with loss of consciousness. Panic attacks are also quite common in severe cases of hypercapnia. The patient may also go into coma in some severe cases.^[3]

How is Hypercapnia Treated?

It is important to identify the cause of Hypercapnia in order to start treatment for it. Some of the treatment options include:

Ventilation: Ventilatory support is essential for people with Hypercapnia. This can be given in two ways either mechanical or noninvasive ventilation. In a noninvasive approach, oxygen is supplied to the patient through a mask to support breathing. This is extremely beneficial for people with sleep apnea as it keeps the airways open. It is also known by the name of CPAP. Mechanical ventilation on the other hand is an approach where breathing support is given through a ventilator. This is given in severe cases of Hypercapnia.^[3]

Medications: There are also certain medications that are found to be effective for treatment of Hypercapnia. This is especially given for conditions like pneumonia or bronchitis that affect the breathing of a person. Antibiotics are the preferred choice for such conditions. The patient may also be given bronchodilators to open up the airways and help in breathing.^[3]

Oxygen Therapy: Some people with Hypercapnia require oxygen therapy to regulate breathing. This is given through a device which delivers oxygen directly through to the lungs. This helps in lowering the levels of carbon dioxide in the blood.^[3]

Lifestyle Modifications: A person with Hypercapnia will have to make certain lifestyle modifications. It is essential for such people to avoid heavily polluted areas as they may irritate the airways and cause problems with breathing. It is also important for people with Hypercapnia to quit smoking to avoid any complications of Hypercapnia and improve their overall health status. They should also try and avoid dust, fumes, and chemicals that may irritate the airways or cause inflammation worsening the symptoms of Hypercapnia.^[3]

Surgery: This is done in people who have damaged lung or airway. The surgery will involve removal of the diseased lung tissue or in severe cases even a lung transplant to decrease the symptoms of Hypercapnia.^[3]

A question that comes in everyone’s mind these days during the times of the pandemic is whether wearing a mask will cause Hypercapnia. This is a misconception and there is no evidence to prove that wearing a mask will cause Hypercapnia. This is because masks used during the pandemic are not airtight and are made such that the person is able to breathe normally. In fact, it helps regulation of carbon dioxide rather than a build-up of it.^[3]

Masks that are thin or made of cloth allow even more air to pass through and thus there is no reason to believe that they will cause accumulation of carbon dioxide. It has been made clear that a person needs to wear a mask only when going out in public or when attending a function or a ceremony. This is only to prevent further spread of the coronavirus.^[3]

This means that a person needs to wear a mask for not more than a couple of hours at a time and this short duration does not cause any build-up of carbon dioxide in the body resulting in Hypercapnia. However, if a person finds it difficult to breathe after wearing a mask should avoid wearing it. Thus it can be said with certainty that masks used for prevention of COVID-19 do not cause Hypercapnia and in fact promote airflow thereby regulating the levels of oxygen and carbon dioxide in the body and in fact works in a way in preventing worsening of the symptoms of Hypercapnia.^[3]

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