HYPOXIA

Dr. Jyoti Prasad Deori

Assistant Professor
Dept of Physiology
HYPOXIA
 DECREASED pO2 IN TISSUES
 CAUSE
 DECREASED

 AVAILABILITY

 DELIVERY

 UTILIZATON
TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA
2. ANAEMIC HYPOXIA
3. STAGNANT HYPOXIA
4. HISTOTOXIC HYPOXIA
Pathophysiology of Anaemic hypoxia
 Mild to moderate anaemia usually does not
produce hypoxia at rest because there is
compensatory increase in 2,3-DPG amount in
RBCs which combines with oxyhaemoglobin &
results in liberation of O2.
 During exercise there is increased demand of O2
by tissues which is not met & symptoms of
hypoxia appears.
 1.HYPOXIC HYPOXIA –
↓ AVAILABILITY OF OXYGEN
 It is due to decrease O2 tension in the
arterial blood(↓pO2) hence it is also called
as arterial hypoxia.
 In this condition O2 carrying capacity &
rate of blood flow, utilization are normal.
Causes of Hypoxic hypoxia
LOW pO2 IN THE HYPOVENTILATION
INSPIRED AIR  Air way obstruction
 High altitude  Depression of
 Mines respiratory centre
DIFFUSION DEFECTS ABNORMAL VENTILATION
 Pulmonary edema PERFUSION RATIO
 Pulmonary fibrosis
 Heart disease
 A-V shunt
 Characteristic features
 Decrease in arterial pO2
 Blood O2 content is also reduced
 Normal rate of blood flow
 The delivery of O2 to tissue affected
 Normal Utilization of O2 by the cells
 2.Anaemic hypoxia
 Occurs due to decreased O2 carrying
capacity of blood.
 Causes of Anaemic hypoxia

I. Decreased RBC count: In bone marrow

depression & haemorrhage.
II. Decreased haemoglobin content
III. Altered haemoglobin: eg: in
methaemoglobinnaemia*,
carboxyhaemoglobin etc.
Characteristics
 pO2 of inspired air normal
 Lungs are normal – no diffusion defect
 But Blood O2 content reduced
 Hence O2 delivery to tissue is reduced
 Normal rate of blood flow & Utilization
of O2
 3.Stagnant Hypoxia
 It occurs due to decreased blood flow to the
tissues so that inspite of normal pO2 &
haemoglobin, adequate O2 is not delivered to the
tissues.
 Causes
 Shock: due to circulatory failure & haemorrhage 
baroreceptor reflex activation  vasoconstriction ↓
blood flow to tissues tissue hypoxia.
 Congestive Heart failure: there is ↓ venous return ↓
blood flow to tissues hypoxia
 Atherosclerosis,thrombus,embolus Intra vascular
obstruction  ↓ delivery of O2 to tissues tissue hypoxia.
Characteristic features
 Rate of blood flow is decreased
 pO2 and O2 content normal
 4. Histotoxic Hypoxia
 It is the decreased ability of the tissue to
utilize O2.
 Causes
 Due to some poisonous substances which
destroy the cellular oxidative enzymes and
completely paralyse the cytochrome oxidase
system* of the cells.
 Eg. Cyanide poisoning – inhibits cytochrome
oxidase function.
Characteristic features

 Rate of blood flow is normal

 CO2 and O2 content normal
 O2 delivery normal but utilization is decreased.
E.g. in Cyanide poisoning.
Oxygen therapy
 Hypoxic hypoxia – very useful
 Anaemic hypoxia – Moderate
 Stagnant Hypoxia – less useful
 Histotoxic Hypoxia – Not useful
 Salient features of hypoxia
Hypoxic Anaemic Stagnant Histotoxic
hypoxia hypoxia hypoxia hypoxia
PO2 in blood  Normal Normal Normal
O2 carrying capacity Normal  Normal Normal
of blood
O2 content of blood   Normal Normal
Blood flow rate Normal Normal  Normal
Tissue Utilize of O2 Normal Normal Normal 
O2 therapy Very useful Moderate Less useful Not useful
A-V difference of O2 Normal Normal 
Cyanosis Present No Present (local) No
 Classification of hypoxia based
on Arterial po2
1. Fulminant Hypoxia - < 20 mm Hg
 Eg. When air craft loses cabin pressure at altitudes above

30,000 ft (with no O2 availability)

 Unconsciousness within few seconds

 Brain death follow in 4-5 min

2. Acute Hypoxia – Arterial PO2 between 20 – 40 mm Hg.

 Eg. 18,000 – 20,000 ft.

 Symptoms – Similar to Alcohol intoxication

 Coma & death – if compensatory mechanisms not

adequate
3. Chronic Hypoxia – Exposure to extended periods of time
to arterial PO2 of 40 – 60 mm Hg. Most common type seen
clinically.
Effects of Hypoxia
 Depends upon the rapidity of onset
 Severity
 Duration of hypoxia
 Organs most susceptible – brain & heart
 Effects of hypoxia - CNS
Rapid and severe
Sudden loss of consciousness - death
Slow
 Similar to Alcoholic intoxication

 Apathetic*

 Loss of self control

 Muscular weakness

 Incoordination

 Easy fatigability

 Loss of discriminative ability & power of judgment

 Visual and auditory acuity diminished

Effects of Hypoxia – CVS
Initially
 Increase in rate and force of contraction

 rise in CO  BP rises
Later
 Force of contraction is reduced BP

falls
Effects of hypoxia –
Respiratory System
 Increased respiratory rate – due to
chemoreceptors
 Large amount of CO2 is washed out
leading to alkalosis*
 Respiration becomes shallow and
periodic
 Depression of Respiratory centre
 Rate and force of breathing - reduced
Effects of hypoxia
On GIT On Kidney
 Loss of appetite  Increased secretion

 Nausea of erythropoietin
 Vomiting  Alkaline urine

 Dryness of mouth

 Thirst sensation
DYSPNOEA
 Difficulty in breathing / Air hunger
 Awareness of the need for increased
respiratory effort
 Involves discomfort and active
participation of accessory respiratory
muscles
 Eg. During strenuous muscular exercise
Conditions when Dyspnea occurs
 Respiratory disorders – obstructive
disorders, pneumonia, pulmonary
edema, pneumothorax
 Cardiac disorders – LV failure, Mitral
Stenosis
 Metabolic disorders – Diabetic acidosis,
uremia
Other respiratory
abnormalities:
 Asphyxia : It is a condition characterized by decreased O2 and
increased CO2 in the body produced by occlusion of the air way.
The typical features seen in asphyxia are as follows,
Stage I ( duration 1 min.) There is pronounced stimulation of
respiration with violent respiratory efforts.
Stage II ( duration 1 min.) The B.P. and heart rate rise sharply,
catecholamine secretion is increased and blood pH falls. There may
be ventricular fibrillation and involuntary micturation and
defaecation.
- By artificial ventilation subject can be revived at this point, otherwise
cardiac arrest follows in 4-5 min.
Stage III ( duration 3 min.) Eventually respiratory efforts cease, the
B.P. falls and H.R. slows. The respiration become gasping with loss
of reflex and pupillary dilatation. Cardiac arrest and death occurs
due to progressive brain damage due to hypoxia and hypercapnia.
Drowning:
 Drowning is an asphyxia caused by immersion, usually in water.
 In 10% of drowning, the 1st gasp of water after losing struggle
not to breath triggers laryngospasm and death results from
asphyxia without any water in the lungs.
 In the remaining cases, the glottic muscles eventually relax and
fluid enters the lungs.
 Fresh water drowning→ fresh water is rapidly absorbed,
diluting the plasma and causing intravascular hemolysis.
 Salt water drowning→ sea water is markly hypertonic and
draws fluid from the vascular system into the lungs, decreasing
plasma volume.
 Treatment: If rescued and resuscitated, these circulatory effect
have to be reversed.
Special types of breathing:
In some diseases and also in health, the normal rhythmic
breathing is changed. Then the condition is called special type
of breathing which are as follows,
 Periodic Breathing : when a normal individual hyperventilates
for 2-3 min. then stops and permits respiration to continue
without exerting any voluntary control over it, there is a period of
apnea. This is followed by a few shallow breaths and then by
another period of apnea, followed again by a few breath. This
pattern is known as ‘Periodic Breathing’. These cycles may
last for sometime before normal breathing is resumed.
 Periodic breathing occurs in various disease states and are of 2
types,
1. Cheyne – strokes breathing : Respiration shows alternate
waxing and waning of tidal volume.
 Seen in,
1. Congestive heart failure

2. Uremia

3. Brain disease

4. During sleep in some normal individuals.

Causes : i) Increased sensitivity to CO2
-disruption of neural pathways that inhibit
respiration
 Relative hyperventilation → Lower the PaCO 2 →
Apnea → Again rises PaCO2 to normal →
Respiration again shows over response to CO 2 →
Breathing ceases and cycle repeats.
ii) Prolongation of the lung to brain
circulation time
So, it takes longer time for changes in arterial gas
tensions to affect the respiratory area in the
medulla.
 Biot’s respiration : When the respiration
is characterized by alternate eupnoea and
apnoea, then it is called Biot’s respiration.
Also called ataxic breathing.
 Seen in, - meningitis
- severe brain damage with
disruption of the normal medullary
rhythmicity.
 Cyanosis: It is the bluish discoloration of the skin and mucous
membrane due to accumulation of reduced Hb > 5 gm%.
 It is of 2 types, peripheral and central
 Peripheral cyanosis is seen in distal part of the body where
perfusion is very poor in hypotensive state and in
vasoconstriction due to cold. Extraction of large amounts of O2
from Hb result in increased deoxygenated or reduced Hb.
Suggestive of stagnant hypoxia.
 Central cyanosis observed at area normally receive high blood
supply and become cyanotic only if the O2 saturation of blood is
low, as in hypoxic hypoxia. Seen in defective oxygenation in the
lungs and in right to left shunt in congenital cyanotic group of
heart diseases.
 Cyanosis does not occur in anaemic and histotoxic hypoxia
 In polycythemia cyanosis may occur normally
 Methaemoglobinaemia mimics cyanosis.
Cerebral symptoms of hypoxia resemble those of alcohol toxicity,
( i.e. impaired judgment, drowsiness or excitement, dulled pain
sensibility, disorientation and headache.)
 OBSTRUCTIVE VS.
RESTRICTIVE
Obstructive disorders Restrictive disorders

• Characterized by: reduction in • Characterized by a reduction

airflow. in lung volume.
• So, shortness of breath  in • So, Difficulty in taking air
exhaling air. inside the lung.

( DUE TO stiffness inside the lung tissue

( the air will remain inside the or chest wall cavity )
lung after full expiration )
1. Interstitial lung disease.
1. COPD 2. Scoliosis
2. Asthma 3. Neuromuscular cause
3. Bronchiectasis 4. Marked obesity
 The diagnosis and distinguished
between obstructive and restrictive
lung diseases.

Confirmed by  Spirometry

SPIROMETRY measures the rate of lung volume changes

during forced breathing maneuvers