Oxygen Toxicity Signs and Symptoms

Dr. K. David Sawatzky is a diving medical specialist on contract at Defence Research and Development Toronto from 1998 to !!". #revio$sly he was the %anadian &orces Staff 'fficer in (yper)aric *edicine at D%+,* -198./19901 and later the Senior *edical 'fficer at 2arrisonS$pport 3nit Toronto -1990/19981. (e has )een on the 4oard of 5dvisors for the +nternational 5ssociation of 6itro7 and Technical Divers -+56TD1 since !!!8 and is an active cave8 trimi7 and closed circ$it re)reather diver9instr$ctor9instr$ctor trainer. The second half of a two part series on oxygen toxicity, first published in Diver Magazine in Feb/Mar 200 ! )y Dr. K. David Sawatzky Text "ast colu#n we focused #ainly on the #echanis#s of oxygen toxicity! This colu#n will continue that discussion with a description of the toxic effects of oxygen on the lungs and the brain! The discussion is fairly technical so it would be advisable to review the last colu#n before continuing with this one! Dr! $! "orrain %#ith first described the toxic effect of oxygen on the lungs in &' ! (e noted that the severity of the effect increased with increasing p)2 and that the effects where largely reversible! *s shown in the diagra#, the toxic effects of oxygen at partial pressures between 0!+, *T* and &!- *T* are pri#arily on the lungs while the toxic effect at p)2s over &!- *T* are pri#arily on the brain! The earliest sign of pul#onary .lung/ oxygen toxicity is a #ild irritation in the trachea .throat/ that is #ade worse with deep inspiration! * #ild cough develops next, followed by #ore severe irritation and cough until inspiration beco#es 0uite painful and the cough beco#es uncontrollable! 1f exposure to oxygen is continued, the person will notice chest tightness, difficulty breathing, shortness of breath, and if exposure is continued long enough, the person will die, fro# lac2 of oxygen3 The progressive da#age to the lungs eventually #a2es it i#possible for the oxygen to get to the blood as it passes through the lungs!

The ti#e to onset of sy#pto#s is highly variable but #ost individuals can tolerate &24&- hours of oxygen at &!0 *T*, '4&+ hours at &!, *T*, and 54- hours at 2!0 *T* before developing #ild sy#pto#s! There are several ways to trac2 developing pul#onary oxygen toxicity but the #ost sensitive and accurate is the develop#ent of sy#pto#s! * second techni0ue is to #onitor the vital capacity! 6ital capacity .the a#ount of air that can be #oved in one large breath/ decreases with increasing pul#onary toxicity! * reduction of approxi#ately 27 in vital capacity correlates with #ild sy#pto#s while a reduction of &07 correlates sy#pto#s so severe that #ost individuals will not voluntarily continue breathing oxygen! These #ild effects are co#pletely reversible and no per#anent lung da#age occurs! (owever, the da#age will ta2e 2 to + wee2s to heal! The pathology of pul#onary oxygen toxicity is understood but beyond the scope of this discussion! * third way to 2eep trac2, in rough ter#s, of pul#onary oxygen toxicity is to 2eep trac2 of the oxygen exposure! This techni0ue is called calculating the 8nit 9ul#onary Toxic Dose .89TD/ and one 89TD is e0uivalent to breathing &007 oxygen, for one #inute, at &!0 *T*! *s a guide, -&, 89TDs in one day will cause a 27 reduction in vital capacity and &,+2, units will cause a &07 decrease! There are several different ways to calculate the 89TD .so#e try to correct for increasing toxic effects with increasing dose, in addition to the si#ple p)2/ and there is 0uite wide variation in individual tolerance so that sy#pto#s are still the best guide! The situation where 89TDs are #ost useful is in planning a large nu#ber of dives, in a few days, all involving a large a#ount of oxygen deco#pression or ::; diving! <ven then, the dive plan #ay have to be altered if the diver develops sy#pto#s of pul#onary toxicity! The first and #ost i#portant #ethod to prevent pul#onary oxygen toxicity is to li#it exposure to the lowest possible p)2 for the shortest period of ti#e! 1f you dive only air and li#it your depth to a #axi#u# of &50 fsw .+0 #sw/, pul#onary oxygen toxicity is unli2ely to be a proble#! The second #ethod to prevent pul#onary oxygen toxicity is to provide air brea2s! The da#age to the cells is cu#ulative and if for every 2, #inutes of oxygen exposure you provide the cells with a five4#inute period where the diver breathes air, the diver can tolerate twice as #uch oxygen before toxic sy#pto#s develop when air brea2s are given co#pared to breathing oxygen continuously! =asically what happens is that during the air brea2s the cells are repairing the da#age due to )2 radicals #uch faster than da#age is occurring so they >catch up? on so#e of the da#age! Therefore, it will ta2e #uch longer for a given level of da#age to accu#ulate! )xygen toxicity of the brain .:@%/ is a proble# of higher p)2s for shorter periods of ti#e! Ahile breathing air, a p)2 of &!- *T* is not reached until a depth of 2&' fsw .-B #sw/! Therefore, :@% oxygen toxicity is not a proble# for standard recreational diving! (owever, #ore and #ore divers are using @itrox and if you dive breathing a +07 oxygen #ixture, the p)2 will be &!- *T* at a depth of only fsw .50 #sw/ and if you deco#press on &007 oxygen, the p)2 will be &!- *T* at a depth of 20 fsw .- #sw/3 Therefore, :@% oxygen toxicity is a serious proble# for so#e recreational divers, and a #aCor proble# for technical and co##ercial divers! The first and #ost serious sign of :@% oxygen toxicity is often a grand4#al type convulsion! There are #any other signs and sy#pto#s of oxygen toxicity but there is no consistent warning that a seizure is about to occur! <ven the <<D is co#pletely nor#al until the convulsion starts! The convulsion due to oxygen toxicity is not believed to cause any per#anent proble#s in and of

itself because the body starts the convulsion with a surplus of oxygen on board and thus the hypoxia seen with nor#al seizures does not occur! (owever, the diver who convulses while in the water #ay drown or, if they ascend while the glottis is closed, #ay suffer pul#onary barotrau#a! There is huge variation in the a#ount of oxygen individuals can tolerate before they show signs of :@% oxygen toxicity and of even #ore concern, a huge variation in the sa#e person on different days! * diver #ay do #any dives in which they are exposed to high p)2s with no difficulties and falsely conclude that they are resistant to oxygen toxicity! Then, for no apparent reason, they #ay suffer a :@% hit on a dive where they are exposed to a lower p)2! 1n general, people can tolerate #ore oxygen in a dry cha#ber than in the water! 1n fact, #ost divers can tolerate two hours of oxygen at 5!0 *T* .-- fsw or 20 #sw/ in a cha#ber with few difficulties! Ahile exercising in the water however, several divers have had convulsions at p)2s as low as &!- *T*! To #a2e #atters worse, in the cha#ber divers often have one of the less serious signs of oxygen toxicity such as tunnel vision, ringing in the ears or twitching, whereas in the water the first sign is often a seizure! The seizure starts with an i##ediate loss of consciousness and a period of about 50 seconds when the #uscles are relaxed! *ll of the #uscles of the body then contract violently for about one #inute! The diver then begins to breathe rapidly and is very confused for several #inutes afterwards! *s you can well i#agine, if this happens during a dive, the diver usually dies! The table gives a short list of the signs and sy#pto#s of :@% oxygen toxicity but al#ost anything is possible! There are so#e factors that are 2nown to increase the ris2 of :@% oxygen toxicity! 1 have already #entioned two, sub#ersion in water and wor2ing hard! The ris2 with wor2ing hard is that the p:)2 in the body is increased and this increases the blood flow to the brain! )ther causes of increased p:)2 are s2ip breathing and increased carbon dioxide in the breathing gas! 1ncreased stress on the diver and increased levels of adrenaline, atropine, aspirin, a#pheta#ine and other sti#ulants all see# to increase the ris2 of :@% oxygen toxicity!

There are no drugs that can be used to prevent :@% oxygen toxicity! 1n ani#al experi#ents, the seizures could be prevented but the :@% cellular da#age found after prolonged seizures still occurred! The only effective #ethods to prevent :@% oxygen toxicity are to li#it the p)2, the ti#e of exposure, and to give air brea2s during oxygen breathing! *s general guidelines, the p)2 during deco#pression while at rest should never exceed 2!0 *T* and #ost divers use &007 oxygen at a #axi#u# depth of 20 fsw .- #sw, &!- *T*/! During the active part of the dive, the p)2 should never exceed &!- *T* and #any divers are using &!,, &!+,

or even &!5 as the #axi#u# p)2 for all parts of the dive! @)**, the 8% @avy, the ;oyal @avy, the :anadian Forces, and #any other organizations have guidelines for acceptable p)2s and the #axi#u# ti#e that #ay be spent at each! 1f you are interested in diving where you will be exposed to increased p)2, it is i#perative that you get appropriate training!