Respiratory Depression

Respiratory Depression – Symptoms – Causes & Treatments

Respiratory Depression

In the medical field, respiratory depression is also known as hypoventilation and occurs when the ventilation in the lungs is insufficient to perform a basic function such as a gaseous exchange. By the term hypoventilation, it causes a high level of carbon dioxide, known as respiratory acidosis and hypercapnia. This depression is not the same term as respiratory arrest, the condition in which the individual feel difficulty in breathing and death occurs within 1-2 minutes due to a high level of CO2  and rapidly change into anoxia. Though, both terms need medical emergencies. It can be considered as the pioneer of hypoxia and its severity is characterized as hypoxia having high toxicity due to carbon dioxide.

Respiratory Depression

Causes of Respiratory Depression

There are many physical and environmental factors that contribute to the severity of the condition. Some important causes are given below:

  • Chronic elevation disorder, a mechanism to use energy
  • A medical situation in which stroke affecting the brain parts
  • Drugs and Medication, typically when taken in intentional or accidental overdose. Opioids, in particular, are regarded to cause respiratory depression. Examples of opioids include pharmaceuticals such as hydromorphone and oxycodone.
  • Voluntary breath-holding or under breathing
  • Hypocapnia, which stimulates respiratory depression

Common Causes

Some medicines, particularly sedatives and some specific health disorder known to develop this depression. Some common causes of hypoventilation are:

  • Poisoning and Ethanol overdose
  • Poisoning or Benzodiazepine overdose
  • Sedative overdose
  • Opiate or opioid (morphine, tramadol, heroin, fentanyl) overdose
  • Severely high blood ammonia as seen in cirrhosis and liver failure
  • Postoperative opioid-induced or anesthetic-related respiratory depression
  • Barbiturate overdose or poisoning
  • Stroke that affects the lower brain stem
  • Central sleep apnea
  • Congenital central hypoventilation syndrome (CCHS)
  • Brain tumor condition of the brain part of the respiratory center

Associated Conditions

The diseases such as (CCHS) congenital central hypoventilation syndrome and (ROHHAD) rapid-onset obesity, hypoventilation, hypothalamic dysfunction with autonomic dysregulation are categorized as the specific situation associated with this particular depression. Congenital central hypoventilation may be an important factor in some condition of the sudden death of an infant known as sudden infant death syndrome or also termed as “crib death” or “cot death”. There is another term for respiratory depression known as hyperventilation in which there is a low concentration of carbon dioxide occur in the lungs and the situation also known as hypercapnia.

Effects of Respiratory Depression

Due to side effects of recreational drugs or other medicines, It becomes a potential life-threatening challenge. Many depressants drugs produce respiratory depression when utilized in high amount or excessive doses are taken or may be mixed with other relaxants. These drugs are:

  • Ethanol
  • GHB
  • Barbiturates
  • Benzodiazepines
  • Sedatives
  • Opioids

The strong opiates are also used as drugs that develop the situation of respiratory depression. These opiates include:

  • Morphine
  • Heroin
  • Fentanyl
  • Benzodiazepines
  • Barbiturates
  • Alprazolam

Due to overdose, a person ceases breathing (also known as respiratory arrest) and that is rapidly fatal without taking any treatment. An overdose of opioids or combined with many other relaxants or depressants is causing serious complications such as fatalities. Other signs of respiratory depression depend on the condition of the individual. In many severe cases, the sign and symptom of the disorder become violent and causes serious diseases related to lungs or respiratory system.

Signs and Symptoms

Associated symptoms include:

  • Lethargy
  • Dizziness
  • Confusion
  • A headache
  • Disorientation
  • Nausea
  • Fatigue

Other critical conditions include:

  • A headache
  • Vomiting
  • Tremors
  • Tinted skin or bluish-colored skin, especially on the fingers and toes
  • Low or high blood pressure
  • Abnormal long pauses are known as apnea, between breathing followed by a deep sigh sounding breath
  • Reduced or pinpoint pupils
  • Slow, shallow breathing with little noticeable chest movement
  • Seizures
  • Low breathing sounds and crackling sound while breathing or a distinct whistling
  • Rapid heart rate

If the condition left untreated, the severe respiratory depression can result in the following:

  • Brain damage
  • Respiratory arrest
  • Coma or death
  • Cardiac arrest
  • Reduced heart rate

If you are feeling like you have respiratory depression and you are feeling the sign and symptoms of the depression, seek medical assistance immediately. If the other person close to you experiencing the same sign and symptoms, it is very important to keep that individual alert and find the best medical treatment. Because, sometimes the individual wants to get some assistance, but can’t get proper guidance related to his condition and in severe cases the patient unable to get enough oxygen immediately. The patient is not the condition to lie down properly and wants to make an attempt to sit straight and trying to breathe easily.

The Symmetry of the Body Needs

The vital organs of your body need a good amount of oxygen for proper working. As this depression occurs, the delivery of oxygen to the whole body becomes limited and the brain does not respond properly. In this situation, the patient starts to confuse about his health and irritated due to unconsciousness and think that the condition is not treatable.

Additional Symptoms

As the condition becomes worse, the patient has difficulty during speaking. They can speak only a few words at a time, not be able to complete their full sentence and what they want to say before trying to take enough oxygen. The research studies show that our body has a great amount of carbon dioxide due to lower respiratory function. The treatment may require instant oxygen for proper breathing with a mechanical machine. Sometimes, the patient gets confused about breathing complications or respiratory depression, so it is important to diagnose the condition either he/she has a respiratory depression or something else.

Diagnosis of Respiratory Depression

Usually, doctors will start an examination by asking some specific questions about the sign and symptoms and review the condition of the patient’s medical history and profile. The doctor will perform a physical examination to check the sign and symptoms of heart rhythms and abnormal breathing. After this initial examination, the doctor usually orders to perform the diagnostic test to confirm that either you have respiratory depression and how to evaluate respiratory depression. Tests used to diagnose the condition include:

  • Screen for other toxins
  • Serum and urine drug screens
  • Alcohol level
  • Electroencephalogram (EEG)
  • Serum ammonia level
  • Computed tomography scan (CT)
  • Magnetic resonance imaging (MRI) used to check any tumor, stroke or brain condition
  • Blood testing used to calculate the ratio of base/acid and the amount of carbon dioxide and oxygen in the blood

Respiratory Depression Treatment

Medicines and some common therapies are used to treat the respiratory depression. These medications include:

  • Fluid therapy, either orally administered or intravenously administration
  • Oxygen therapy
  • Mechanical ventilation
  • If caused by high amount of doses, detoxification, often using medicines that work against the effects of opioids, such as Suboxone, naloxone, and methadone
  • Continuous positive air pressure, BiPAP or CPAP machines

Prevention Strategies for Respiratory Depression

The respiratory depression is not prevented and causing sudden disease or accidents. However, some cases can be prevented. There are some specific strategies that are used to prevent this depression, these strategies include:

  • Monitoring children while taking prescribed medications
  • Avoiding, or taking extra precautions when using sedative medications
  • Taking or avoiding extra precautions when using narcotic medications
  • Avoiding excessive alcohol use

Many people having a chronic type of respiratory depression. the individuals who have the chest infection or any other deformities such as chronic obstructive pulmonary disease and neuromuscular disorders have more options for developing respiratory depression. Some people are fatty and can suffer from low breath rate and even in some situations stop breathing during sleeping and resulted in sudden death. respiratory depression and hypoventilation are the same words and have the same meaning of disease. Slow breathing is known as bradypnea and fast breathing is known as hypopnea, both situations develop the causes of respiratory depression. Very fast and slow breathing also develop many other health complications that ultimately leads towards respiratory depression.

Before knowing the specific meaning of respiratory depression, it is important to know that how opiates are the reason of developing respiratory depression. Both terms have a strong association with lungs. Respiratory depression regarded as a feeling of extreme urge to breath. This condition develops a specific pattern such as sighing during breathing, which is known as long pauses in a deep breath. The condition sedation is something else that develops with a strong association of respiratory depression and results from the use of an opiate. When the high amount of opiates are taken or some other drugs with the combination of opiates, it results in respiratory depression proved to be highly toxic for the lungs as well as other parts of the body.

Levels of Respiratory Depression

There are many levels of depression from many drugs to opiates that are based on the intensity of the respiratory depression. The situation increases with the opiates amount that a person used. Different levels are given below:

  • Minimal respiratory depression
  • Moderate respiratory depression
  • Severe respiratory depression

Minimal Respiratory Depression

This condition is totally unnoticed. Usually, it occurs with very small doses of drugs used. If the person uses a slightly higher dose, there might be an upper level of minimal respiratory depression.

Moderate Respiratory Depression

An affected person uses a high amount of opiates, it develops the condition known as moderate respiratory depression. The sign and symptoms of the condition become noticed by everyone easily. Short breath, easily tired, can’t speak properly and regular use of opiates is the basic sign and symptoms. A person feels more uncomfortable in every situation or wants to seek assistance instantly. A medical emergency is a normal condition in this situation. Environmental factors also affect badly in this condition.

Severe Respiratory Depression

When a person uses a very high amount of opiates, the condition develops known as severe respiratory depression. This condition slows down to a basic activation point when people noticed the sign and symptoms. This condition leads towards death if the condition remains untreated. A person feels extreme sedation, low oxygen level, and short breath. The condition is also carried out by the confusion and extreme depression that a person feels like he/she stop breathing if don’t put the main focus on what they are doing or what they want to do. At end stage, the respiratory burst occurs. The respiratory system fails to perform proper function and lungs are also badly affected. A person feels the following severe sign and symptoms:

  • Lose consciousness
  • Stop breathing or shortage of oxygen in the lungs
  • Color changes from normal to blue
  • Opioid overdose
  • Coma
  • Eventually, death occurs

The high usage of opiates causes respiratory depression and the individual also feel sedated when they can’t wake up by themselves and also being deprived y low amount of oxygen. Commonly,  this can happen when the individual takes too many opioids, but the situation also occurs when a person pair them with sleeping or alcohols. Another risk of opioids use in terms of respiratory depression occurs when someone wants to take the high amount and has unnoticed sleep apnea. These drugs can retard the normal function of the central nervous system and make it improper for the whole body functioning. Our central nervous system is responsible for the marinating breathing and heartbeat and makes our body to perform the proper function in sudden situations.

Other Signs & Symptoms

The opiates and respiratory depression is a complex process that both can make a strong association. When a person starts to take a high amount of opiates, it slows down the working of the central nervous system, that in returns slows down the breathing. The more amount of opiates, you take, more breathing can be slowed down. The basic sign of opiate overdose in someone who has a low rate of breathing and fewer than 10 breaths in a minute.

Other signs and symptoms are paired with the respiratory depression during the use of other drugs includes:

  • Pinpoint pupils
  • Odd mood changes
  • Seeming confused
  • Slow movements
  • Uncontrollable vomiting
  • Nausea
  • Having problems staying awake

If someone wants to have a high dose of drugs and also experiencing visible signs of respiratory depression, they likely to need opioids antagonist such as naloxone. These severe conditions demand emergency respiratory depression treatment.

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