The clinical recognition of carbon dioxide intoxication.

Within the last century, man has escaped early death only to become increasingly susceptible to age and the cumulative small insults of daily existence. There has been a shift to the right on the spectrum of disease. The focus has been readjusted to include not only the acute, fulminating episode, but also the chronic, long-term state. Chronic pulmonary disease exemplifies this trend and stands as an ever increasing problem of medical and socio-economic importance. Concomitant with the increasing prevalence of chronic pulmonary disease is the parallel need for a more thorough understanding of the basic pathophysiology, diagnosis and clinical management of such disorders. There is a real need for a universal appreciation of the primary and secondary manifestations of the chronic lung diseases. Carbon dioxide intoxication emerges from this framework as a syndrome which must be familiar to every physician who treats long term pulmonary diseases. Yet, this symptom complex continues to pass unnoticed and untreated. For years its symptoms have been unknowingly intensified and the gravity of its course inadvertently increased by treatments of the uninformed. There exists the challenge of making this syndrome known to every practicing physician, medical student and nurse. The cause is vital and contemporary. This challenge will prevail until carbon dioxide intoxication becomes routinely stressed in student and house staff education, until it becomes a part of our major medical and surgical texts, and until it becomes firmly established in the differential diagnosis of the comatose state. It is the purpose then of this paper to review the syndrome of carbon dioxide intoxication with emphasis on its clinical manifestations and pathophysiology. Included is an original quantitative survey of this symptom complex in which all the reported cases of the major contributors are analyzed as a group. In addition, 11 unreported cases from the files of the Veterans Administration Hospital, Los Angeles, California, have been summarized by the author and are presented in this review.