Diagnosis of hypercapnia requires ABG analysis. The results of pulse oximetry analysis can be normal, depending on other factors. With acute hypercapnia, the serum bicarbonate level increases slightly due to mass action through the CO 2-bicarbonate equilibrium: bicarbonate increases about 1 meq/L for each increase of 10 mmHg in the PaCO2. Patients with chronic hypercapnia have an elevated serum bicarbonate concentration due to the renal response to increased Pa co2: the serum bicarbonate concentration increases about 3.5 meq/L for each increase of 10 mmHg in the Pa co2.

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