Hypercapnia-induced cerebral oedema in a patient with COPD exacerbation: a rare and under-recognised entity

Description

A 56-year-old Caucasian woman with severe chronic obstructive pulmonary disease (COPD) on home oxygen presented with a severe exacerbation. Vitals included a blood pressure of 111/73 mm Hg, a pulse of 102/minute, respiratory rate of 13/minute and O₂ saturation of 84% on oxygen of 2–3 L/minute by nasal cannula. She was lethargic, confused and was wheezing. She was placed on bi-level positive airway pressure (BiPAP) but her mentation continued to deteriorate. White cell counts were normal. Chest X-ray showed hyperinflated lungs but no infiltrates. Arterial blood gases revealed severe hypercapnic respiratory acidosis with a pH of 7.26, pCO₂ of 100.1 mm Hg, pO₂ of 187 mm Hg and bicarbonate of 47 mmol/L. In spite of BiPAP, her acidosis worsened with a pCO₂ of 131 mm Hg. She was intubated for acute hypercapnic respiratory failure. Although her deteriorating mentation correlated with CO₂ narcosis, it was judicious to perform neuroimaging like cerebral CT to rule out other causes...

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