Flapping Tremor as a Diagnostic Tool for Evaluation of Hypercapnia

Abstract

A 76 year-old woman was admitted to our hospital because of aspiration pneumonia. Four days after initiation of the antibiotic treatment, her respiratory status became to be better; however, hypoxemia was recurred with tachypnea (36 breaths/min). On physical examination, she had a hot hand and flapping tremor, but not loss of consciousness, suggesting of acute type 2 respiratory failures with the increased level of PCO2 ranged from 15 to 30 mmHg. Accumulation of the evidence showed that the PCO2 retention from the usual level for each patient could be assessed by physical sings. Thus, even in the modern era, general physicians can easily diagnose the rapid increase the level of PCO2 from the prior status by using the physical findings such as hot hands, flapping tremor, and loss of consciousness as in the present case.