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a pulmonary surfactant deficient lung is characterized by collapesd air-spaces alternating with hyperexpanded areas, vascular congestion and in time, hyaline membranes. Hyaline membranes are composed of fibrin, cellular debris, RBC, rare neutrophils and macrophages. They appear as an eosinophilic, amorphous material lining or filling the air spaces and blocking gas exchange. As a result, Blood passing through the lungs is unable to pick up oxygen and unload CO2-->Blood O2 levels down and CO2 levels rises-->resulting in rising blood acid levels (metabolic acidosis) and hypoxia.
 

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There is respiratory acidosis in nrds.. It is a restrictive disease and so lack of surfactant causes collapse during expiration -> shunt like state there will be -> Hypoxemia which will lead to hyperventilation- but the the kid will still have RESP ACIDOSIS as theres retention of co2 more
 
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