Hypoxia and Cyanosis Hypoxia and Cyanosis

Jethro M. Macallan, MD Jethro M. Macallan, MD

Definition of Terms Definition of Terms
Hypoxia Hypoxia
a a pathological pathological condition in which the body condition in which the body
as a whole or a region of the body is as a whole or a region of the body is
deprived of adequate deprived of adequate oxygen oxygen supply supply
Cyanosis Cyanosis
bluish or purplish tinge to the skin and bluish or purplish tinge to the skin and
mucous membranes mucous membranes
Definition of Terms Definition of Terms
Hypoxemia Hypoxemia
the oxygen concentration within the the oxygen concentration within the
arterial blood is abnormally low arterial blood is abnormally low
Anoxia Anoxia
Type of hypoxia in which there is complete Type of hypoxia in which there is complete
deprivation of oxygen supply deprivation of oxygen supply
Classification Classification
Hypoxemic hypoxia Hypoxemic hypoxia
hypoxia caused by low hypoxia caused by low partial pressure partial pressure of of
oxygen in arterial blood oxygen in arterial blood
Examples: Examples:
- - High altitude High altitude
- - Switching from inhaled anesthesia to Switching from inhaled anesthesia to
atmospheric air atmospheric air
- - Sleep Apnea Sleep Apnea
- - COPD COPD
- - Shunts Shunts
Classification Classification
Hypemic hypoxia Hypemic hypoxia
arterial oxygen pressure is normal, but arterial oxygen pressure is normal, but
total oxygen content of the blood is total oxygen content of the blood is
reduced reduced
Hypoxia due to failure to deliver oxygen to Hypoxia due to failure to deliver oxygen to
target tissues target tissues
CO poisoning CO poisoning
Methemoglobinemia Methemoglobinemia
Classification Classification
Histotoxic hypoxia Histotoxic hypoxia
cells are unable to effectively use the cells are unable to effectively use the
oxygen due to disabled oxidative oxygen due to disabled oxidative
phosphorylation enzymes phosphorylation enzymes
schemic or Stagnant hypoxia schemic or Stagnant hypoxia
local restriction in the flow of otherwise local restriction in the flow of otherwise
well well- -oxygenated blood oxygenated blood
Effects Effects
switch from aerobic to anaerobic
metabolism
Can cause cell swelling and cell death
Adaptations: upregulation of genes
including phosphoglycerate kinase and
phosphofructokinase, Glut-1 and Glut-2,
VEGF and erythropoietin
Effects Effects
Systemic arterioles dilate
Opening of K
ATP
channels in vascular
smooth-muscle cells
Vasoconstriction in the lungs
inhibition of K
+
channels causes
depolarization
activates voltage-gated Ca
2+
channels
Shunts blood away from poorly ventilated
toward better-ventilated portions
Causes Causes
Respiratory Hypoxia
Hypoxia Secondary to High Altitude
Hypoxia Secondary to Right-to-Left
Extrapulmonary Shunting
Anemic Hypoxia
Carbon Monoxide (CO) ntoxication
Circulatory Hypoxia
Specific Organ Hypoxia
ncreased O2 Requirements
mproper Oxygen Utilization
Respiratory Hypoxia
Ventilation-perfusion mismatch resulting
from perfusion of poorly ventilated alveoli
poventilation
Intrapulmonar right-to-left shunting
Hypoxia Secondary to High Altitude
Breathing air Breathing air Breathing pure oxygen Breathing pure oxygen
AItitude AItitude
(ft) (ft)
Barometric Barometric
pressure pressure
PO2 in PO2 in
air air
PCO2 in PCO2 in
aIveoIi aIveoIi
PO2 in PO2 in
aIveoIi aIveoIi
Oxygen Oxygen
Saturation Saturation
PCO2 PCO2
in in
aIveoIi aIveoIi
PO2 in PO2 in
aIveoIi aIveoIi
Oxygen Oxygen
Saturation Saturation
0 0 760 760 159 159 40 (40) 40 (40) 104 104
(104) (104)
97 (97) 97 (97) 40 40 673 673 100 100
10,000 10,000 523 523 110 110 36 (23) 36 (23) 67 (77) 67 (77) 90 (92) 90 (92) 40 40 436 436 100 100
20,000 20,000 349 349 73 73 24 (10) 24 (10) 40 (53) 40 (53) 73 (85) 73 (85) 40 40 262 262 100 100
30,000 30,000 226 226 47 47 24 (7) 24 (7) 18 (30) 18 (30) 24 (38) 24 (38) 40 40 139 139 99 99
40,000 40,000 141 141 29 29 36 36 58 58 84 84
50,000 50,000 87 87 18 18 24 24 16 16 15 15
Hypoxia Secondary to Right-to-Left
Extrapulmonary Shunting
Anemic Hypoxia
Carbon Monoxide (CO) ntoxication
Circulatory Hypoxia
Specific Organ Hypoxia
ncreased O2 Requirements
Exercise
increasing the cardiac output and ventilation O2
delivery to the tissues
preferentially directing the blood to the
exercising muscles
increasing O2 extraction from the delivered
blood and widening the arteriovenous O2
difference
reducing the pH of the tissues and capillary
blood, shifting the Hb-O2 curve to the right
mproper Oxygen Utilization
Adaptations Adaptations
chemosensitive cells in the carotid, aortic
bodies and in the respiratory center
increases ventilation
cerebrovascular resistance decreases and
cerebral blood flow increases
systemic vasodilation occurs - raises CO
increase in the Hgb conc. and the RBCs
Cyanosis Cyanosis
Most marked in the lips, nail beds, ears,
and malar eminences
becomes apparent when the concentration
of reduced hemoglobin in capillary blood >
4 g/dL
Cyanosis Cyanosis
entral anosis
SaO2 is reduced or an abnormal Hgb
derivative is present, and the mucous
membranes and skin are both affected
!eripheral anosis !eripheral anosis
slowing of blood flow and abnormally great
extraction of O2 from normally saturated
arterial blood
CAUSES OF CYANOSS
Central Cyanosis
Decreased arterial oxygen saturation
Decreased atmospheric pressurehigh
altitude
mpaired pulmonary function
- Alveolar hypoventilation
- Uneven relationships between pulmonary
ventilation and perfusion (perfusion of
hypoventilated alveoli)
- mpaired oxygen diffusion
CAUSES OF CYANOSS
Central Cyanosis
Anatomic shunts
- Certain types of congenital heart disease
- Pulmonary arteriovenous fistulas
- Multiple small intrapulmonary shunts
Hemoglobin with low affinity for oxygen
CAUSES OF CYANOSS
Central Cyanosis
Hemoglobin abnormalities
Methemoglobinemiahereditary, acquired
Sulfhemoglobinemaacquired
Carboxyhemoglobinemia (not true
cyanosis)
CAUSES OF CYANOSS
Peripheral Cyanosis
Reduced cardiac output
Cold exposure
Redistribution of blood flow from
extremities
Arterial obstruction
Venous obstruction
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