Gas Exchange III

Utilization Coefficient

The O2 being utilized by the body At rest 25% for skeletal muscle while for cardiac muscle = 70% In exercise increased to 75 85% %age of blood that gives up its oxygen while passing through peripheral tissue capillaries

Oxygen transport in dissolved state 3% 0.17 ml/dl of blood Hb-CO COMBINATION: CO affinity for Hb is 250 times more as compared to oxygen CO poisoning can be lethal , oxygen Pp is normal, no clinical signs of hypoxemia (cyanosis)

Due to lack of oxygen patient becomes disoriented and un conscious No feedback mechanisms to correct deficiency of oxygen Patient can get benefit from oxygen and CO2 therapy

Transport of CO2

CO2 20% more dissolvable than O2 in body fluids CO2 produced in more quantity than can be dissolved 4 ml CO2 given out at lung level CO2 transported in three ways PCO2 of venous blood = 45 mmHg CO2 dissolved = 2.7 ml/dl PCO2 of arterial blood = 40 mmHg CO2 dissolved is 2.4 ml/dl

So only 0.3 ml of CO2 transported as dissolved form in plasma = 7% 93% CO2 diffused into RBCs. In RBC either binds directly with Hb to form Hb-CO2 or converted to HCO3 ion 23% CO2 form Hb-CO2 70% CO2 form HCO3 ion Formation of HCO3 ion a CO2 transportation b Buffers metabolic acids

In RBC CO2 + H2O H2CO3 H+ +HCO3 Reaction Reversible and obeys the law of mass action To keep the reaction move on H+ HCO3 removed as H+Hb H.Hb & HCO3 gets out from RBC into plasma Done by chloride shift Antiport transport Also called Hamburgs shift Exchange of one Cl- & one HCO3 Cl inside RBC RBC size bigger Venous blood MCV , Hematocrit 3%greater than of arterial blood

At lung level dissolved CO2 diffused out, draws dissolved CO2 from RBC CO2 HCO3 balance disturbed law of Mass action Cl HCO3 exchange in reverse direction Carbaminohemoglobin 23% directly attached with Hb Also attached with other plasma proteins but not significant

HELDANE EFFECT

Combination of O2 with Hb forming Hb a strong acid CO2 displacement( at level of lungs) a Acidic Hb less affinity for CO2 b Acidic Hb release of H+ ion to form H2CO3 & then CO2 which is released into lung At tissue level O2 removed and so more affinity for CO2 (Bohr effect).

Respiration During Exercise

Pulmonary ventilation Rate & Depth of respiration Temp Respiration Metabolic rate respiration Body consumption of O2 at rest 250ml/mints, In exercise 4 5L/mints O2 extraction ratio 25%, in exercise 75 80%

Oxygen diffusing capacity inc. 65ml/min/mmHg CO2 diffusing capacity inc. 1200 ml/min/mmHg.

O2 Debt

Usual body storage of O2 = 2L 1 0.3 L in muscle fibers to Myoglobin 2 1L to Hb 3 0.5L in Alveolar air 4 0.25L in dissolved form in body fluids After exercise this 2L reservoir of O2 must be replenished by breathing over & above the normal requirement

In addition 8 9 L needed to reconstitute ATPs consumed during exercise So total 10-12 L of O2 needed after exercise to be at normal called O2 debt O2 debt repaid during 90 minutes rapid breathing after exercise During exercise both nervous & chemical stimulation of respiration

The additional oxygen that must be taken in to body after vigorous exercise to restore all systems to their normal states is called oxygen debt. After exercise 4 tasks need to be completed Replenishment of ATP Removal of lactic acid Replenishment of myoglobin with oxygen Replenishment of glycogen

High altitude Changes

Atmosph. Pressure at sea level=760mmHg and PO2=160mmHg As one ascends Atmosph. pressure keeps on decreasing Composition or percentage of constituent gases remains same At 10,000 feet = 523 mmHg , PO2 in air=110mmHg At 50,000 feet = 87 mmHg, PO2 in air=18mmHg Acclimatization try to be normal at high altitude despite low levels of oxygen.

Acclimatization

1. 2. 3. 4. 5.

At 10,000 feet, atmosph pressure = 523 and alveolar PO2 = 67mmHg The changes in body in response to hypoxia if somebody stays at high altitude for sometime are Great increase in pulmonary ventilation Increases RBCs number Increased diffusing capacity of lungs Increased vascularity of the tissue Increased ability of tissue cells to use oxygen despite low PO2

Increased Pulmonary Ventilation

Hypoxic stimulation of resp. center by peripheral Chemoreceptors Immediate compensation to PO2 by, alveolar ventilation to CO2 exhalation. This decreased PCO2 inhibitory effect on resp. center, opposing the stimulatory effect of dec. PO2 After a few days stimulatory effect overwhelms inhibitory effect b/c of HCO3 ions in brain(kidneys excrete bicarbs)

Increased RBCs Count

Hypoxia erythropoietin RBC production Hct from normal (40-45) to 60-65 Hb from normal (15mg/dl) to 20-22 g/dl

Increased Diffusing Capacity

Pulmonary capillary blood vol. capillaries expanding surface area Also inc in air vol. surface area Inc in pulm. artery blood pressure more perfusion So diffusing capacity for O2 from normal (21 ml/mint/mmHg) to 65 ml/mint/mmHg

Increased Vascularity of Tissue

(Circulatory Changes)

Initially cardiac out by 30% approx. As Hct - C.O. becomes normal in number of capillaries in non-pulmonary areas called increased capillarity (angiogenesis) Hypoxia pulmonary vasoconstriction Retrograde pressure on Rt heart Rt ventricular hypertrophy Pulmonary vasoconstriction pulmonary hypertension

Cellular Acclimatization

More capillary formation in tissues vascularity Also number of mitochondria & Cytochrome oxidase enzyme

Acute Mountain Sickness

May be nausea, vomiting, headache, Irritability, dyspnoea, at 12000ft At 18000 ft - twitching, seizures At 23000 ft coma leading to death Cerebral vasodilatation in response to hypoxia fluid leakage into cerebral tissue cerebral edema disorientation & other cerebral dysfunction Pulmonary edema exact cause not known Takes 8-24 hrs to develop

Chronic Mountain Sickness

RBC count - so Hct Pulmonary arterial pressure Rt heart hypertrophy failure Hct blood viscosity sluggish circulation decreased O2 supply to peripheral tissues Natives at high altitude

Chest barrel shaped chest larger Body size decreased- high ratio of ventilatory capacity to body mass Aortic & carotid bodies of bigger size Pulmonary hypertension & Rt ventricular hypertrophy RBC count with Hct

Deep Sea Diving & Hyperbaric Condition

Atmospheric pressure = 760 mmHg Deep into sea, at every 33 feet pressure rises by 1 atmosphere Vol. of air compressed & pressure increased along with depth Deep sea diver breath high pressure air

Nitrogen Narcosis at High Nitrogen Pressure

About 4/5th of air nitrogen At sea level no ill effect of nitrogen but at high pressure (deep in sea) varying degree of narcosis First symptom of narcosis joviality, at 120 feet deep, after remaining for some time At 150 200 feet Drowsy At 200 250 feet Strength wanes, Beyond 250 feet person cant move

Nitrogen narcosis is like alcohol intoxication, impaired memory, impaired thought making Nitrogen mech. Same as that of gas anesthesia Nitrogen 5 time more soluble in fat than in water At sea level 1 L of nitrogen dissolved in entire body, half in body fluids & half in fat ( though fat constitutes 15% of total body) At 33 feet deep 2 L of nitrogen get dissolved in body At 100 feet deep 4 L of nitrogen Nitrogen can not be metabolized in body Diver ascends slowly to sea level In case of rapid ascent decompression sickness

Decompression Sickness

Also called bends, compressed air sickness, caisson disease, divers paralysis, dysbarism During rapid ascent, sufficient amount of nitrogen bubbles develop in body fluids either extra or intra cellularly Depending upon the no. & size of nitrogen bubble, any area of the body can get damage Bubble formation in brain vessels paralysis; Around nerves paraesthesia itching, severe pain; Around joints severe pain in joints (called bends); In pulmonary vessels Dyspnoea & chokes, coronary arteries cardiac damage

Treatment of rapid ascent to sea level

Recompression of divers with the same pressure under which they remain in the sea
Then decompression done gradually

Respiratory Exchange Ratio

R = Respiratory exchange ratio, between O2 transport & CO2 transport = 4/5 = 0.8

Respiratory Quotient (RQ)

Almost similar to R Ratio of CO2 output and O2 consumed per units time, same as exchange ratio = 0.8 RQ - when on carbohydrate rich diet RQ - when on fat rich diet R & RQ - in hyperventilation, severe exercise, metabolic acidosis, R & RQ - - Metabolic alkalosis, hypoventilation or just after the exercise.