Dr.

Niranjan Murthy HL
Asst Professor
Dept of Physiology
SSMC, Tumkur
Hypoxia: lack of oxygen at tissue level
Anoxia: complete absence of oxygen in
tissues
Types:
4. Hypoxic Hypoxia
5. Anemic Hypoxia
6. Stagnant Hypoxia
7. Histotoxic Hypoxia
 Hypoxic Hypoxia
 Low PaO2
 Normal O2 carrying capacity and blood flow
Causes:
 Low PO2 in inspired air- high altitude
 Decreased pulmonary ventilation- airway
obstruction, paralysis of respiratory muscle,
narcotics
 Defect in exchange of gases through the
membrane
 A-V shunts- cyanotic congenital heart disease
• Characteristic features:
PaO2- 40 mm Hg; PvO2- 2 mm Hg
%O2 saturation- arterial 75%; venous 45%
O2 content- arterial 14 ml/dL; venous 9
ml/dL
O2 utilization- 5 ml/dL
A-V PO2 difference- 15 mm Hg
 Hypoxic hypoxia
Via peripheral chemoreceptors

Respiratory center

Increased pulmonary ventilation

Reduced PaCO2

Shift to left of O2-Hb curve

Reduced O2 release from Hb

Tissue hypoxia
 Anemic Hypoxia
• Arterial PO2 is normal
• Reduced Hb content
• Causes:
(iv) Anemia
(v) Carbon monoxide poisoning
• Characteristic features:
 PaO2- 95 mm Hg; PvO2- 40 mm Hg
Reduced % saturation of Hb
O2 content of blood is reduced

• Hypoxia is not severe at rest because of

increase in 2,3 DPG

• Severe hypoxia during exercise

 Carbon monoxide poisoning
• CO combines with Hb at the same point
where O2 combines
• CO has 250 times more affinity than O2
• Shifts O2-Hb dissociation curve to left
• Treated with 100% O2 or O2-CO2 mixture
(95% + 5%)
 Stagnant Hypoxia
• Normal Hb% and PaO2
• Reduced blood flow to tissues
• Causes:
(iv) Circulatory failure
(v) Hemorrhage
• Characteristic features:

PO2- arterial 95 mm Hg; venous 25 mm Hg

%O2 saturation- arterial 97%; venous 45%

O2 content- arterial 19 ml/dL; venous

9 ml/dL
 Histotoxic Hypoxia
• Tissue utilization of O2 is hampered

• Normal O2 supply to tissues

• Cause: cyanide poisoning

• Characteristic features:

PO2- arterial 95 mm Hg; venous 90 mm Hg

%O2 saturation- arterial 97%; venous 96%

O2 content- arterial 19 ml/dL; venous

18.5 ml/dL
 Effects of hypoxia
• On Respiration: increase ventilation via
peripheral chemoreceptors
• On CNS: drowsiness, disorientation,
reduced pain sensibility, emotional
outbursts, tremors, cheyne-stoke
respiration, death (when %O2 falls below
60)
• On CVS: increase HR and BP
 Treatment of hypoxia
Oxygen administration is of importance in hypoxic
hypoxia.

• Inhalation of 100% O2 at normal atmospheric

pressure

B. Hyperbaric oxygen therapy

 Normobaric 100% O2 therapy
• It is useful in hypoxic hypoxia.
Dangers of inhaling 100% oxygen:
Produce nasal congestion, throat pain,
cough, substernal discomfort, etc by
stimulating irritant receptors.
Cause bronchopneumonia if given for
more than 24 hrs by inhibiting alveolar
macrophages
Newborns should not be given more than
40% oxygen
 Hyperbaric O2 Therapy
• Useful in anemic, stagnant and histotoxic
hypoxia
• Inhalation of 100% O2 at 1 atm can
increase arterial PO2 to 673 mm Hg as it
includes PCO2 of 40 mm Hg and PH2O of 47
mm Hg
• At 1 atmospheric pressure, oxygen
dissolved in plasma is 2ml/dL (i.e 673 x
0.003)
• 3 atm of pure O2 will deliver resting O2
needs
• Oxygen toxicity will occur early

• Inhibits tissue enzyme activity

• Cerebral vasoconstriction

• Muscular twitches, tinnitus, jerking

respiration, convulsions and coma
 CYANOSIS
• Bluish discoloration of skin due to
presence of 5 gm% of reduced Hb
• Sites- lips, undersurface of tongue, ear
lobes, nail bed, tip of the nose
• Causes- hypoxic hypoxia and stagnant
hypoxia
• CO poisoning- cherry red discoloration