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Respiratory acidosis is an acid–base disorder that occurs when the lungs cannot remove enough carbon dioxide from the body. As carbon dioxide accumulates in the blood, it combines with water to form carbonic acid, causing blood pH to decrease. This condition commonly develops when breathing is slow, shallow, or otherwise inadequate.

Several conditions can lead to respiratory acidosis, including chronic obstructive pulmonary disease, severe asthma, pneumonia, sleep-related breathing disorders, chest wall abnormalities, and neuromuscular diseases. Certain medicines, particularly sedatives and opioids, can also suppress breathing and contribute to carbon dioxide retention. Respiratory acidosis may be acute, developing suddenly, or chronic, occurring gradually over time.

Symptoms depend on the severity and speed of onset. They may include headache, drowsiness, confusion, fatigue, shortness of breath, and difficulty concentrating. Severe cases can cause reduced consciousness and other serious complications.
Diagnosis usually involves arterial blood gas analysis to evaluate pH and carbon dioxide levels. Additional tests may help identify the underlying lung, neurological, or medication-related cause.

Treatment focuses on improving ventilation and addressing the underlying problem. Depending on severity, management may include oxygen therapy, bronchodilators, non-invasive ventilation, or mechanical ventilation. Treating the underlying condition and monitoring blood gases are essential for restoring normal acid–base balance.