DESCRIPTIVE

CLASSIFICATION OF THE CAUSES OF HYPOXIA:

1. Inadequate oxygenation of the blood in the lungs because of extrinsic reasons
a. Deficiency of O2 in the atmosphere
b. Hypoventilation (neuromuscular disorders)
2. Pulmonary disease
a. Hypoventilation caused by increased airway resistance or decreased
pulmonary compliance
b. Abnormal alveolar ventilation-perfusion ratio (including either increased
physiological dead space or increased physiological shunt)
c. Diminished respiratory membrane diffusion
3. Venous-to-arterial shunts (“right-to-left” cardiac shunts)
4. Inadequate O2 transport to the tissues by the blood
a. Anemia or abnormal hemoglobin
b. General circulatory deficiency
c. Localized circulatory deficiency (peripheral, cerebral, coronary vessels)
d. Tissue edema
5. Inadequate tissue capability of using O2
a. Poisoning of cellular oxidation enzymes
b. Diminished cellular metabolic capacity for using oxygen because of toxicity,
vitamin deficiency, or other factors

HYPOXIC CIRCULATORY ANEMIC HISTOTOXIC
HYPOXIA HYPOXIA HYPOXIA HYPOXIA
Hb N N decreased N
Blood flow to N decreased N N
tissues
Characterized deficiency of low blood flow blood does not have inability of cells to
by: oxygen in the enough capacity to utilize the oxygen
atmosphere. carry oxygen. delivered.

arterial O2 decreases N significantly N

content decreased
Arterial PO2 decreased N N N
Arterial %O2 decreased N decreased N
saturation of
Hb
Notes - High altitude - Circulatory Anemia - cells are unable
(low PO2 in insufficiency Bleeding to utilize oxygen
inspired air) - bleeding Methemoglobinemia - cyanide
- decreased - heart failure CO poisoning posioning
alveolar
ventilation.
- gas exchange
failure
(mismatch V/Q)
- venous arterial
shunt
Effects of Hypoxia: Respiratory Stimulation
• Dyspnea
o difficult or labored breathing in which the person is conscious
of shortness of breath
• Hypernea
o increase in the rate or depth of breathing
• Tachypnea
o rapid, shallow breathing
o increasing ventilation compensating for loss of oxygen

Chronic Mountain Sickness
• high RBC mass and hematocrit (increased viscosity decreases tissue blood
flow and O2 delivery)
• Pulmonary arterial pressure becomes more elevated
o pulmonary arterioles vasoconstrict
o pulmonary shunt
• enlargement of right side of heart
• peripheral arterial BP begins to fall
• congestive heart failure
• death

Compensatory Responses to Hypoxia
• increased pulmonary ventilation (tachypnea)
• increased RBC and [Hb]
• increased lung diffusing capacity
• increased tissue capillarity
• cellular acclimatization (increased # of mitochondria and cellular oxidative
enzymes)
o increased cell’s ability to use O2 despite low O2

Cyanosis
• bluish discoloration of skin
• excessive amounts of deoxygenated Hb in blood vessels and capillaries
• deoxygenated Hb = dark blue purple color
• Central cyanosis - deoxygenated Hb > 5g/100mL in arterial blood
Low PCO2
• caused by decreased arterial O2
o stimulates peripheral chemoreceptors thereby increasing ventilation
o increase in ventilation decreases arterial PCO2 => minimize hypoxemia

Increased pH
• respiratory alkalosis
• caused by decrease in PCO2 => rise of HCO3

Medication: hyperbaric oxygen inhalation



Oxygen Therapy – tent, mask, intranasal tube
• atmospheric hypoxia – 100% effective
• hypoventilation hypoxia – breathing in 100% O2 = 5x O2 movement into
alveoli each breath
• hypoxia caused by impaired alveolar membrane diffusion – “”
• hypoxia caused by anemia, abnormal hemoglobin transport of O2, circulatory
deficiency, or physiological shunt,
o small amount of extra O2, (7-30 %), can be transported in the
dissolved state in the blood when alveolar O2 is increased to
maximum
• hypoxia caused by inadequate tissue use of O2 - no benefit from oxygen
therapy