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Hypoxia

Harliansyah, Ph.D
Dept. BioMed YARSI University

Hypoxia is referred to a pathological process in


which oxygen supply to tissues or organs is
inadequate to meet the demand of cells, or there is
adequate delivery to tissue but the tissue cells cannot
make use of oxygen, leading to changes in functions,
metabolisms and structures of cells and tissues of
the body.
Supply inadequate of oxygen
functions
Utilized disturbance of oxygen metabolisms
damage
structures

Objective Contradiction:
large amount O2 consumption ---250ml/min (360L/day)

Small amount O2 storage ---1.5L (sustain life only six minutes)


Hypoxia is a fundamental pathologic process.
Hypoxia is always direct causes of death.

2. Parameters of blood oxygen


1.partial pressure of oxygen (PO2):
normal value : NPaO2= 13.3kpa (100mmHg)
NPvO2 = 5.3kpa (40mmHg)

influence factor: (1) PO2 of inhalation air


(2) extrarespiratory function
(3) shunting of blood

2. Oxygen binding capacity (CO2 max):


N.V: NCaO2 max =NCvO2max=20ml/dl
I . F: Hb---- (1) quantity
(2) quality or affinity with O 2

3. Oxygen content (CO2):


N.V: NCaO2 = 19ml/dl
NCvO2 = 14ml/dl
N(CaO2 CvO2) = 5ml/dl
I . F: (1) PO2
(2) CO2max : Hb quantity
quality

4. Oxygen saturation (SO2):


SO2 (CO2 dissolved
O2/CO2max)100%
N.V: NSaO2 = 95%
NSvO2 = 70%
I . F: (1) ability of oxygen combined with Hb
(2) SO2 is determined by PO2 at normal
affinity

oxygen dissociation curve :


The relationship curve between PO2 and SO2
Fig.

S ( sigmoid shaped )

I . F: [H+]
pCO2
temperature

a. right shift
b. affinity

2,3- DPG
[H+]
pCO

a. left shift

5. P50:
P50 is the PO2 at the 50% SO2
N. V: N P50 = 26 27 mmHg
I . F: right shift P50
left shift P50

3. Types/Causes/Mechanisms/Features
of hypoxia
The processes of oxygen supplied and
utilization contains:
a. lung intake oxygen
b. Hb carring O2
c. circulation transporting O2
d. cell utilizing O2
Therefore, hypoxia can be divided into four
types .

1. Hypotonic hypoxia (hypoxic hypoxia)

PO2
2. Hemic hypoxia (isotonic hypoxemia)

CO2 maxor(disorders of oxygen release)


3.Circulatory hypoxia (hypokinetic hypoxia)
Blood flow
4.Histogenous hypoxia (dysoxidative hypoxia)
Failure to utilize the oxygen

1. Hypotonic hypoxia (hypoxic hypoxia)


Causes:
a. Decreased PO2 of inhaled air atmospheric
hypoxia
b. disturbance of extrarespiration respiratory
hypoxia
c. shunting of blood

mechanisms:
PaO2 CO2 SaO2 inadequate supply O2 to
tissue

Features:
a. PaO2 PvO2
b. CaO2 CaO2
c. CO2max = N
d. SaO2
e. (CaO2 - CvO2)or N
f. central cyanosis
g. Respiratory compensation

2. Hemic hypoxia (isotonic hypoxemia)


causes:
a. Anemia anemic hypoxia
b. carbon monoxide poisoning
c. Methemoglobinemia
d. higher affinity of Hb to oxygen

Mechanisms :
a. CO2max CO2 afford O2 to tissue
b. CO2max N orbut affinity O2 released
disorder afford O2 to tissue

Features: a. PaO2 =N, PvO2 =N


b. CaO2 CvO2
c. CO2max ( except higher
affinity )
d. SaO2: anemia = N
intoxication
higher affinity
e. (CaO2 - CvO2)

3.Circulatory hypoxia (hypokinetic hypoxia)


Causes:
a.General circulatory dysfunction e.g. shock; heart failure.
b.Local circulatory deficiency e.g. stenosis; occlusion; thrombosis.

Mechanisms:
Reduced tissue perfusiona. ischemia hypoxia
b. congestive hypoxia

Features:
a. PaO2 = N

PvO2

b. CaO2 = N CvO2
c. CO2max = N
d. SaO2 = N
e. (CaO2-CvO2)
f. peripheral cyanosis
g. Respiratory compensation or not

4.Histogenous hypoxia (dysoxidative hypoxia)


Causes:
a.Cell poisoning:
cyanide poisoninghistotoxic hypoxia
b.Mitochondria injury:
radiation ; oxygen free radical
c. Inadequate synthesis of biological oxidation
coenzyme :
deficiency of vitamin B2 or PP

Mechanisms:
Disorder of biological oxidation or
oxidative phosphorylation failure to
utilization of oxygen ATP.

Features:
a. PaO2 = N, PvO2
b. CaO2 = N, CvO2
c. CO2max = N
d. SaO2 = N
e. (CaO2-CvO2)
f. No cyanosis

The changes of blood oxygen parameters


in four types of hypoxia
Type
Hypotonic hypoxia

PaO2

SaO2

O2 capacity

CaO2

or N

Hemic hypoxia

Circulatory hypoxia

Histogenic hypoxia

Note: decrease;

increase;

or N

CaO2-CvO2

or N

N normal.

4.Functional and metabolic changes of


the body in hypoxia
1. Respiratory system
PaO2 ( <8Kpa ) chemoreceptors
respiratory rate and depth hyperventilation.
Severe hypoxia depressing respiratory
center slow and periodic or irregular breathing
stop of breathing.

2.circulatory system
a.Cardiac output : tachycardia arrhythmia
myocardial contractility
b.Redistribution of blood To afford blood to
heart and brain
c.Pulmonary vasoconstriction pulmonary
arterial hypertension right heart failure

3.Hemic system
a. Rightward shift of oxyhemoglobin dissociation
curve
b. Increase of red blood cell: erythropoietin(EPO)

4.Central nervous system:


Dysfunction.

5.Cell
Compensation: a. increased ability to use O2
b. anaerobic glycolysis
c. increase of myoglobin

Damage: a. cellular membrane injury


b. mitochondria impairment
c. lysosome break

5. Factors involved in tolerance to


hypoxia
a. Oxygen consumption rate
Brain oxygen consumption rate tolerance
Skin oxygen consumption rate tolerance

b. Compensatory ability of the body

6. Oxygen treatment and oxygen


toxicity
All patients with hypoxia can be treated with
inhalation of oxygen , but the efficiency is quite different to
every type of hypoxia.
Efficiency:
Hypotonic hypoxia the best
Histogenous hypoxia the worst
When the patient inhaled high pressure of oxygen(PO2
higher than a half atm) ,a series of toxic signs and
symptoms was appeared, this condition is termed as
oxygen toxication.

Oxygen toxication:
1. Pulmonary oxygen toxication
2. Cerebral oxygen toxication

The mechanisms of oxygen toxicity:


Reactive oxygen species or oxygen free radicals .