Oxygen Toxicity

Oxygen Therapy

• 100 % (PURE ) oxygen at normal

pressure : Hypoxic Hypoxia

• Hyperbaric Oxygen Therapy (HBOT) :

100 % oxygen at high pressure : Anemic
and stagnent hypoxia

• Not useful in histotoxic anaemia

 HBOT

• Improves blood flow

• Used in Gas gangrene ,

decompression sickness,
arterial gas embolism,
osteomyelitis, and
myocardial infarction
 Toxic effects depends on :
• Dose and rate of delivery
• Duration : acute or chronic
• Pressure : normal atm, HBOT, diving

Hyperbarism
Every 10 m of sea
water (33 feet)
increased by 1 atm
(760 mm Hg)
Reactive Oxygen Species
(ROS) : PRO-OXIDANTS

Hydrogen peroxide H2O2

Hypochlorous acid HClO
Free Radicals of Oxygen
• Superoxide (O 2 - )
• Hydroxyl ( .OH)
• Peroxynitrite (ONO2 - )
If Accumulates in body ….
…… causes tissue damage
 Anti-oxidants

• This damage is prevented by some enzymes

Glutathione peroxidase, Catalase ,

• with help of some ions : Fe 3+ chromium , copper , cobalt, zinc
• vitamins : vit C and vit
Superoxide dismutase
• Carotenoids and flavanoids )

• There should be balance between antioxidants and pro-oxidants

If there is IMBALANCE ….
Causes damage to tissue
OXIDATIVE STRESS
Hyperoxic condition

ROS
Antioxidant enzymes
Inactivation

Lipid peroxidation
Nucleic acid inhibition
Free radicals Protein synthesis
accumulates inhibition 7
 100 % oxygen at
normal pressure
Chronic
• (Pulmonary toxicity – ‘Lorraine Smith
effect)
• Sometimes mild irritation in
8 hrs : Tracheo bronchial irritation
• Not serious & can be quickly reversed
• lung passageway congestion
• Pulmonary edema
• Decreased surfactant
 100 % oxygen at
normal pressure

Chronic
• (Pulmonary toxicity – ‘Lorraine
Smith effect)
• More than 3 days (Sometimes in
24 hrs)
• Fibrosis , Atelectasis /collapse
• Lung cyst
 100 % oxygen at
normal pressure

Chronic
• Ocular effects
• Blurring of vision
• Myopia
• Cataract
• Oxygen induced retinopathy
• Reversible constriction of
peripheral visual field
100 % oxygen at high
pressure ( 2 - 3 atm)
Chronic
• Similar effects
• But can occur early
100 % oxygen at high pressure
( more than 3 atm = 2280 mm Hg)

Acute
• All previous plus CNS
• CNS Toxicity = ‘Bert effect
• 4 atm : ½ hour
• 6 atm : few minutes
CNS toxicity = Bert effect
• early manifestations are variable:

• twitching of perioral and small muscles of the

hand
• Ear ringing ( Tinnitus)
• vertigo and nausea

• followed by altered behaviour and convulsions

(seizures )…then COMA
Premature newborns at a greater risk
(less than 30 weeks of gestation or
1,500 grams birth weight)

• high concentration of oxygen

above 40% for a prolonged period
(1-2 days) following birth.

• Ocular effects
opaque membrane behind the lens.
• Retrolental fibroplasia
• Premature retinopathy

one of the largest single cause of

blindness during childhood
Toxic effects on other tissues

 Abnormal RBC morphology with

Occasional episodes of haemolysis
following HBOT.

 skin numbness and itching,

 Serous otitis media and dysbaric

osteonecrosis in astronauts during
space flights.
 Prevention
• careful monitoring: continuous watch for
any symptom

• Hyperbaric therapy : use less than 3 atm

• Deep sea diving : decrease conc. To 20 %

• Newborn : use less than 40 %