@article{83320db8f3c846a8ab04c5d38437bf77,
title = "The neurologic syndrome due to marked hypercapnia, with papilledema",
abstract = "A case of chronic obstructive pulmonary emphysema is presented which is noteworthy for the marked degree of CO2 retention, with pCO2 levels up to 150 mm. Hg; papilledema recurrent during a five year period; unusually high spinal fluid pressure (up to 600 mm. of spinal fluid); and the exhibition of the full range of clinical and physiologic manifestations of the syndrome of CO2 narcosis. The case illustrates the advantages and disadvantages of mechanical respiratory assistance and tracheotomy, and that, despite almost lethal CO2 retention, intensive management may be rewarded by clinical improvement.",
author = "Albert Miller and Bader, {Richard A.} and Bader, {Mortimer E.}",
note = "Funding Information: On admission, the patient complained of swelling of the right leg, twitching, confusicn and extreme dyspnea. On physical examinaticn, he was well developed and well nourished, but exhibited marked tachypnea, labored respiration, dusky cyanosis, plethora and suffused conjunctivas. Bilateral papilledema (4 diopters) with a few retinal hemorrhages was seen on funduscopic examination. The anteroposterior diameter of the chest was increased. Wheezes were heard diffusely. Subcrepitant &es were audible at the base of the right lung. Heart sounds were distant. The liver was enlarged 4 cm. below the right costal margin and slightly tender. There was 4-plus edema of the right leg up to the thigh, and 2-plus edema of the left leg. Asterixis and twitching were observed, but no mental changes were noted. Laboratory examination revealed hemoglobin 14.9 gm. per cent, hematocrit 53 per cent, red blood cells 6,420,OOO per cu. mm., reticulocytes 2.8 per cent, Slight anisocytosis, polychromatophilia and hypochromia were seen in the blood smear. Bromsulfalein retention was 15 per cent in forty-five minutes. Blood urea nitrogen was 49 mg. per cent, serum calcium 8.8 mg. per cent, phosphorus 2.5 mg. per cent, total bilirubin 4.3 mg. per cent, direct-reacting bilirubin 1.6 mg. per cent, cholesterol 130 mg. per cent, the cephalin flocculation test was 2 plus. On several determinations, the serum sodium was slightly elevated or normal (147 to 156 mEq. per L.), potassium slightly elevated or normal (3.7 to 5.0 mEq. per L.), chloride reduced (89 mEq. per L.), and CO2 content (venous blood) elevated (40.0 to 45.0 mEq. per L.). Serum total protein, albumin, globulin, alkaline phosphatase and uric acid were all normal. The protein-bound iodine was 3.2~ per cent. Chest roentgenogram showed apical bullae, depressed diaphragms and a prominent pulmonary artery shadow. Electrocardiogram revealed low voltage and diphasic T waves. Abnormal slowing was noted in the electroencephalogram. Lumbar punc- * From the Department of Medicine and the Cardiopulmonary Laboratory of the Mount Sinai Hospital, New York, New York, This study was performed during a tenure of U. S. Public Health Service Grant H-41 33 and a grant from the Robert S. Clark Foundation. Manuscript received October 26, 1961. t Present address: U. S. Public Health Service, P. 0. Box 432, Miami, Florida.",
year = "1962",
month = sep,
doi = "10.1016/0002-9343(62)90028-1",
language = "English",
volume = "33",
pages = "309--318",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "2",
}