Dead Space & Gas Exchange

💨 Anatomical dead space (~150 mL) = air in conducting airways with no alveoli → no gas exchange

🔺 High V/Q (e.g., pulmonary embolism) = dead space ↑ → arterial CO₂ tension (PaCO₂) ↑ if ventilation fixed

🫁 O₂ more affected than CO₂ (CO₂ diffuses faster)

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🧬 X-ALD = VLCFA Overload!

• Cause: ABCD1 mut → ↑ VLCFA

• Triad:

• Neurodegen (demyelination)

• Adrenal insuff (Addison’s)

• ↑ VLCFA (plasma assay)

• Tx:

• HSCT (early cerebral)

• Gene therapy (Skysona™) — emerging

• Lifelong steroids: glucocorticoids ± mineralocorticoids

• Lorenzo’s oil — controversial/adjunct

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