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Hypoxia

Definition
Reduced availability of oxygen to tissues
Anoxia refers to absence of oxygen, used olden days. Now abandoned because
there is no possibility for absence of oxygen
Causes
1. Oxygen tension in arterial blood
2. Oxygen carrying capacity of blood
3. Velocity of blood flow
4. Utilization of oxygen by cells
Classification:
1. Hypoxic hypoxia
2. Anemic
3. Stagnant
4. Histotoxic
Hypoxic Hypoxiawe
decreased oxygen content in blood, arterial hypoxia
causes:
- low oxygen tension in inspired air
o oxygen tension in inspired air is reduced in: high altitude, while
breathing air in closed space, breathing gas mixture containing low
partial pressure of oxygen
- respiratory disorders associated with decreased pulmonary ventilation
o pulmonary ventilation decreases in: obstruction of respiratory
passage, poliomyelitis, brain tumors, pneumothorax
- respiratory disorders associated with inadequate oxygenation of blood in
lungs
o conditions like: emphysema, filling of alveoli with fluid, bronchial
obstruction, lack of surfactant, abnormal pleural cavity,
bronchiectasis
- cardiac disorders:
o congestive heart failure oxygen availability and diffusion are
normal but blood cannot be pumped from heart properly
Anemic Hypoxia
Inability of blood to carry enough amount of oxygen. Oxygen availability is
normal but blood is not able to take sufficient amount due to anemic condition
Causes: any condition that causes anemia
- Decreased number of RBCs
o Conditions like bone marrow diseases and hemorrhage
- Decreased hemoglobin content in blood
o Conditions which decrease the RBC count or change the structure
shape and size of RBC
- Formation of altered hemoglobin
o Mehtemoglobin is formed by oxidation of iron into ferric form,
which cannot combine with oxygen. Quantity of hemoglobin
available for transport is decreased.
- Combination of hemoglobin with gasses other than O2 and CO2
o Hemoglobin combines with carbon monoxide, hydrogen sulfide or
nitrous oxide, looses capacity to transport oxygen
Stagnant hypoxia
Caused by decreased velocity of blood flow, hypokinetic hypoxia
Causes: occurs mainly due to reduction in velocity of blood flow
- Congestive cardiac failure, hemorrhage, surgical shock, vasospasm,
thrombosis, embolism
Histotoxic hypoxia
Produced by the inability of tissues to utilize oxygen
Causes: due to cyanide or sulfide poisoning which destroys the cellular oxidative
enzymes.

Effects
Acute and severe hypoxia leads to unconsciousness, brain death can occur
Two types:
1) Immediate effects
- Effects on blood
o Induces secretion of erythropoietin from kidney, increases
RBC production
- Effects on cardiovascular system
o Increase in rate and force of contraction of heart, cadiac output
and blood pressure
- Effects on respiration
o Respiratory rate increases due to chemoreceptor reflex
- Effects on digestive system
o Associated with loss of appetite, nausea, and vomiting
- Effects on kidneys
o Increased secretion of erythropoietin, alkaline urine is excreted
- Effects on central nervous system
o Similar to those of alcoholic intoxication
2) Delayed effects
- Person becomes highly irritable and develops symptoms of mountain
sickness such as nausea, vomiting, depression, weakness, and fatigue
Treatment
Oxygen therapy: treating the affected person with oxygen. Pure oxygen or oxygen
combined with another gas is administered.
Two methods:
1) Placing the patients in tent containing oxygen
2) Allowing the patient to breathe oxygen either from a mask or intranasal tube


Can be given under normal or high atmospheric pressure
1) Normal atmospheric pressure
- Administration of pure oxygen is well tolerated by patient for long
house, however after 8 hours or more, lung tissues show fluid effusion
and edema
2) High atmospheric pressure (hyperbaric oxygen)
- Pure oxygen with high atmospheric pressure of 2 or more, 2 to 3
atmosphere is tolerated by patient for 5 hours during which dissolved
form of oxygen increases in arterial blood.
- Oxygen toxicity develops when pure oxygen is administered for long
periods.
Efficacy of oxygen therapy in different types of hypoxia
o Not effective equally in all types of hypoxia: hypoxic (100%), anemic
(70%), stagnant (less than 50%), histotoxic (not useful at all)




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