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| {{Infobox symptom
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| | Name = Hypoxia
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| | Image = Cynosis.JPG
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| | Caption = [[Cyanosis]] of the hand in someone with low oxygen saturations
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| | DiseasesDB = <!-- no entry -->
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| | ICD10 =
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| | ICD9 = {{ICD9|799.02}}
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| | MeshID = D000860
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| '''Hypoxia''' (also known as '''hypoxiation''') is a condition in which the body or a region of the body is deprived of adequate [[oxygen]] supply. Hypoxia may be classified as either ''generalized'', affecting the whole body, or ''local'', affecting a region of the body. Although hypoxia is often a [[pathological]] condition, variations in arterial oxygen concentrations can be part of the normal physiology, for example, during [[hypoventilation training]]<ref>Woorons, Xavier, ''[http://www.hypoventilation-training.com/Activity.html Hypoventilation training, push your limits!]'' Arpeh, 2014, 164p. (ISBN 978-2-9546040-1-5)</ref> or strenuous physical exercise.
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| Hypoxia differs from [[hypoxemia]] in that hypoxia refers to a state in which oxygen supply is insufficient, whereas [[hypoxemia]] refers specifically to states that have low arterial oxygen supply.<ref>{{cite book |last=West |first=John B. |title=Pulmonary Pathophysiology: The Essentials |year=1977 |publisher=Williams & Wilkins |pages=22 |isbn=0-683-08936-6}}</ref> Hypoxia in which there is complete deprivation of oxygen supply is referred to as "anoxia".
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| Generalized hypoxia occurs in healthy people when they ascend to [[high altitude]], where it causes [[altitude sickness]] leading to potentially fatal complications: [[high altitude pulmonary edema]] ([[HAPE]]) and [[high altitude cerebral edema]] ([[HACE]]).<ref name=MedicalProblems>{{cite journal |author=Cymerman, A; Rock, PB |title=Medical Problems in High Mountain Environments. A Handbook for Medical Officers |publisher=US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report |volume=USARIEM-TN94-2 |url=http://archive.rubicon-foundation.org/7976 |accessdate=2009-03-05}}</ref> Hypoxia also occurs in healthy individuals when breathing mixtures of gases with a low oxygen content, e.g. while diving underwater especially when using closed-circuit [[rebreather]] systems that control the amount of oxygen in the supplied air. A mild and non-damaging intermittent hypoxia is used intentionally during [[altitude training]]s to develop an athletic performance adaptation at both the systemic and cellular level.<ref>{{cite journal |author=Gore CJ, Clark SA, Saunders PU |title=Nonhematological mechanisms of improved sea-level performance after hypoxic exposure |journal=Med Sci Sports Exerc |volume=39 |issue=9 |pages=1600–9 |date=September 2007 |pmid=17805094 |doi=10.1249/mss.0b013e3180de49d3 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0195-9131&volume=39&issue=9&spage=1600}}</ref>
| | <br><br>Two days after Samsung unveiled the Galaxy Tab 7.7 at IFA, all traces of the tablet vanished from the South Korean firm's presentation area. The question as to why can be answered into two words: Germany and Fruit.<br><br>Of your house found this item you have to look a phone a good answering software program. This may not be necessary the majority of people possess a cellular phone with voicemail to carry out the same be a landline or home phone line. Ensuring that you have an approach to contact for business emergencies is vital. If there is an problem with a shipment or product you can be reached quickly a great immediate resolution to the situation.<br><br>IFA getting held in Berlin, Saudi arabia. Since a connected with Samsung items are not effortlessly sale in Germany, considering issues with Apple patents, the Galaxy Tab 10.7 bore a sticker that said "Not purchase in Denmark." That said, it's believed that wasn't enough for Germany authorities, and Samsung was forced to download the device from its booth.<br><br>After you join the program, the system will provide you with real time alerts via email or SMS. These trading alerts tell you exactly to be able to buy or any relevant details, such as trailing prevents.<br><br>Downloading podcasts becomes smoother. You can make involving the 3G technology steer clear of the My3G app, makes it possible for users to watch after television shows and podcasts downloaded from iTunes. Perfect also watch videos on youtube using this app.<br><br>The greatest reason to obtain a riding lawn mower is also its main selling point. With a trimmers, you're placement mow your grass without putting effort into carpet at a lot of. If you exactly how to drive a car, then you will that mowing your grass will require about the same types of skills. Should get serve as being a lot of encouragement for anybody who seriously like to mow the lawn but lacks the conditioning or abilities necessary to use another connected with mower. Anyone who has a riding lawn mower, however, will find it very in order to understand simply drive around and revel in all of your benefits of experiencing a great yard.<br><br>For trimmers the best recommendation tend to be the Andis T-Outliner, which rrs known for a special T-shape blade rendering it trimming the hairs within the ears a pleasant task. For the detachable blade trimmer one can get the Oster 76 because this one can work on both wet and dry hair, so it is rather versatile. It is usually considered turn out to be the best detachable clipper ever shop bought. For adjustable blade clipper the best recommendation would be your Andis Improved Master.<br><br>When you adored this post and you would want to get details concerning [http://www.ractiv.com/ gesture control] i implore you to go to our internet site. |
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| Hypoxia is also a serious consequence of [[preterm birth]] in the neonate. The main cause for this is that the lungs of the human fetus are among the last organs to develop during pregnancy. To assist the lungs to distribute oxygenated blood throughout the body, infants at risk of hypoxia are often placed inside an incubator capable of providing [[continuous positive airway pressure]] (also known as a humidicrib). {{citation needed|date=October 2013}}
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| ==Signs and symptoms==
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| ===Generalised hypoxia===
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| The symptoms of generalized hypoxia depend on its severity and acceleration of onset.
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| In the case of [[altitude sickness]], where hypoxia develops gradually, the symptoms include light-headedness / fatigue, numbness / tingling of extremeties, nausea and anorexia.<ref>{{cite book |last1=Robinson first1=Grace |last2=Strading first2=John |last3=West first3=Sophie |title=Oxford Handbook of Respiratory Medicine |year=2009 |publisher=Oxford University Press |pages=880 |isbn=0199545162}}</ref> In severe hypoxia, or hypoxia of very rapid onset, [[ataxia]], confusion / disorientation / hallucinations / behavioral change, severe headaches / reduced level of consciousness, [[papilloedema]], [[tachypnea|breathlessness]],<ref>{{cite book |last1=Robinson |first1=Grace |last2=Strading |first2=John |last3=West |first3=Sophie |title=Oxford Handbook of Respiratory Medicine |year=2009 |publisher=Oxford University Press |pages=880 |isbn=0199545162}}</ref> pallor,<ref>{{cite book |last1=Illingworth |first1=Robin |last2=Graham |first2=Colin |last3=Hogg |first3=Kerstin |title=Oxford Handbook of Emergency Medicine |year=2012 |publisher=Oxford University Press |pages=768 |isbn=0199589569}}</ref> [[tachycardia]] and [[pulmonary hypertension]] eventually leading to the late signs [[cyanosis]], [[bradycardia]] / [[cor pulmonale]] and [[hypotension]] followed by death.<ref>{{cite book |last1=Hillman |first1=Ken |last2=Bishop |first2=Gillian |title=Clinical Intensive Care and Acute Medicine |year=2004 |publisher=Cambridge University Press |pages=685 |isbn=1139449362}}</ref><ref>{{cite book |last1=Longmore |first1=J. |last2=Longmore |first2=Murray |last3=Wilkinson |first3=Ian |last4=Rajagopalan |first4=Supraj |title=Mini Oxford Handbook of Clinical Medicine |year=2006 |publisher=Oxford University Press |pages=874 |isbn=0198570716}}</ref>
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| Because [[haemoglobin]] is a darker red when it is not bound to oxygen ([[deoxyhaemoglobin]]), as opposed to the rich red color that it has when bound to oxygen ([[oxyhaemoglobin]]), when seen through the skin it has an increased tendency to reflect blue light back to the eye.<ref>{{cite book |last1=Ahrens |first1=Thomas |last2=Rutherford |first2=Kim |last2=Kimberley |first2=Basham |title=Essentials of Oxygenation: Implication for Clinical Practice |year=1993 |publisher=Jones & Bartlett Learning |pages=194 |isbn=0867203323}}</ref> In cases where the oxygen is displaced by another molecule, such as carbon monoxide, the skin may appear 'cherry red' instead of cyanotic.<ref>{{cite book |last1=Ramrakha |first1=Punit |last2=Moore |first2=Kevin |title=Oxford Handbook of Acute Medicine |year=2004 |publisher=Oxford University Press |pages=990 |isbn=0198520727}}</ref>
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| ===Local hypoxia===
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| If a tissue is not being perfused properly, it may feel cold and appear pale; if severe, hypoxia can result in [[cyanosis]], a blue discoloration of the skin. If hypoxia is very severe, a tissue may eventually [[gangrene]]. | |
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| Pain may also be felt at or around the site.
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| ==Cause==
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| Oxygen passively diffuses in the lung [[alveoli]] according to a pressure gradient. Oxygen diffuses from the breathed air, mixed with water vapour, to [[artery|arterial]] blood, where its partial pressure is around 100 mmHg (13.3 kPa).<ref name="02_calc">{{cite web | author=Kenneth Baillie and Alistair Simpson | title=Altitude oxygen calculator | url=http://www.altitude.org/oxygen_levels.php | publisher= Apex (Altitude Physiology Expeditions) | accessdate=2006-08-10}} – Online interactive oxygen delivery calculator.</ref> In the blood, oxygen is bound to hemoglobin, a protein in [[red blood cell]]s. The binding capacity of hemoglobin is influenced by the [[:wikt:partial pressure|partial pressure]] of oxygen in the environment, as described in the [[oxygen–hemoglobin dissociation curve]]. A smaller amount of oxygen is transported in solution in the blood. {{citation needed|date=October 2013}}
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| In peripheral tissues, oxygen again diffuses down a pressure gradient into cells and their [[mitochondria]], where it is [[cellular respiration|used to produce energy]] in conjunction with the breakdown of [[glucose]], [[fat]]s and some [[amino acid]]s. {{Citation needed|date=August 2013}}
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| Hypoxia can result from a failure at any stage in the delivery of oxygen to cells. This can include decreased partial pressures of oxygen, problems with diffusion of oxygen in the lungs, insufficient available hemoglobin, problems with blood flow to the end tissue, and problems with breathing rhythm.
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| Experimentally, oxygen diffusion becomes rate limiting (and lethal) when arterial oxygen partial pressure falls to 40 mmHg (5.3 kPa) or below. {{Citation needed|date=August 2013}}
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| ===Ischaemia===
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| {{Main|Ischemia}}
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| [[Ischaemia]], meaning insufficient blood flow to a tissue, can also result in hypoxia. This is called 'ischaemic hypoxia'. This can include an [[embolus|embolic event]], a [[myocardial infarction|heart attack]] that decreases overall blood flow, or trauma to a tissue that results in damage. An example of insufficient blood flow causing local hypoxia is [[gangrene]] that occurs in [[diabetes]]. {{citation needed|date=October 2013}}
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| Diseases such as [[peripheral vascular disease]] can also result in local hypoxia. For this reason, symptoms are worse when a limb is used. Pain may also be felt as a result of [[lactic acid]] created as a result of [[anaerobic metabolism]].
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| ===Hypoxemic hypoxia===
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| {{Main|Hypoxemia}}
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| This refers specifically to hypoxic states where the arterial content of oxygen is insufficient.<ref>{{cite book |last=West |first=John B. |title=Respiratory Physiology: The Essentials |publisher=Wolters Kluwer Lippincott Williams & Wilkins |location=La Jolla |year=2008 |pages=88–89 |edition=8th}}</ref> This can be caused by alterations in [[respiratory drive]], such as in [[respiratory alkalosis]], physiological or pathological shunting of blood, diseases interfering in lung function resulting in a [[ventilation-perfusion mismatch]], such as a [[pulmonary embolus]], or alterations in the [[partial pressure]] of oxygen in the environment or lung alveoli, such as may occur at altitude or when diving.
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| ===Problems with hemoglobin===
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| Almost all the oxygen in the blood is bound to hemoglobin, so interfering with this carrier molecule limits oxygen delivery to the periphery. Hemoglobin increases the oxygen-carrying capacity of blood by about 40-fold,<ref name=MARTIN1999>{{cite book|last=Martin|first=Lawrence|title=All you really need to know to interpret arterial blood gases|year=1999|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=0-683-30604-9|edition=2nd ed.}}</ref> with the ability of hemoglobin to carry oxygen influenced by the partial pressure of oxygen in the environment, a relationship described in the [[oxygen–hemoglobin dissociation curve]]. When the ability of hemoglobin to carry oxygen is interfered with, a hypoxic state can result.<ref name=DAVIDSONS2010>{{cite book|first=the editors Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston ; illustated by Robert Britton|title=Davidson's principles and practice of medicine.|year=2010|publisher=Churchill Livingstone/Elsevier|location=Edinburgh|isbn=978-0-7020-3085-7|edition=21st ed.}}</ref>{{rp|997–999}}
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| ====Anemia====
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| {{Main|Anemia}}
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| Hemoglobin plays a substantial role in carrying oxygen throughout the body,<ref name=MARTIN1999 /> and when it is deficient, [[anemia]] can result, causing 'anaemic hypoxia' if tissue [[perfusion]] is decreased. [[Iron deficiency]] is the most common cause of anemia. As iron is used in the synthesis of hemoglobin, less hemoglobin will be synthesised when there is less iron, due to insufficient intake, or poor absorption.<ref name=DAVIDSONS2010 />{{rp|997–999}}
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| Anemia is typically a chronic process that is compensated over time by increased levels of [[red blood cell]]s via upregulated [[erythropoetin]]. A chronic hypoxic state can result from a poorly compensated anaemia.<ref name=DAVIDSONS2010 />{{rp|997–999}}
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| ====Carbon monoxide poisoning====
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| {{Main|Carbon monoxide poisoning}}
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| [[Carbon monoxide]] competes with oxygen for binding sites on hemoglobin molecules. As carbon monoxide binds with hemoglobin hundreds of times tighter than oxygen, it can prevent the carriage of oxygen.<ref>{{cite journal|last=Douglas|first=CG|coauthors=Haldane, JS, Haldane, JB|title=The laws of combination of hemoglobin with carbon monoxide and oxygen.|journal=The Journal of physiology|date=Jun 12, 1912|volume=44|issue=4|pages=275–304|pmid=16993128|pmc=1512793}}</ref>
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| [[Carbon monoxide]] poisoning can occur acutely, as with smoke intoxication, or over a period of time, as with cigarette smoking. Due to physiological processes, carbon monoxide is maintained at a resting level of 4-6 ppm. This is increased in urban areas (7 - 13 ppm) and in smokers (20 - 40 ppm).<ref name = "CO ppm">{{cite journal|last=Wald|first=NJ|coauthors=Idle, M, Boreham, J, Bailey, A|title=Carbon monoxide in breath in relation to smoking and carboxyhaemoglobin levels.|journal=Thorax|date=May 1981|volume=36|issue=5|pages=366–9|pmid=7314006|pmc=471511}}</ref> A carbon monoxide level of 40 ppm is equivalent to a reduction in hemoglobin levels of 10 g/L.<ref name = "CO ppm" /><ref>The formula <math> Hb_{CO}(%) = \frac {CO - 2.34} {5.09} </math> can be used to calculate the amount of carbon monoxide-bound hemoglobin. For example, at carbon monoxide level of 5 ppm, <math>= \frac {5 - 2.34} {5.09} = .5%</math>, or a loss of half a percent of their blood's hemoglobin. (Wald et al., 1981)</ref>
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| CO has a second toxic effect, namely removing the allosteric shift of the oxygen dissociation curve and shifting the foot of the curve to the left. In so doing, the hemoglobin is less likely to release its oxygens at the peripheral tissues.<ref name = AllYouReally>
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| Martin, Lawrence. (1992) All you really need to know to interpret arterial blood gases. 2nd edition ISBN 0-683-30604-9
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| </ref> Certain [[hemoglobinopathies|abnormal hemoglobin variants]] also have higher than normal affinity for oxygen, and so are also poor at delivering oxygen to the periphery.
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| ====Cyanide poisoning====
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| Histotoxic hypoxia results when the quantity of oxygen reaching the cells is normal, but the cells are unable to use the oxygen effectively, due to disabled oxidative phosphorylation enzymes. This may occur in [[Cyanide poisoning]]. {{Citation needed|date=August 2013}}
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| ====Other====
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| Hemoglobin's function can also be lost by chemically oxidizing its iron atom to its ferric form. This form of inactive hemoglobin is called [[methemoglobin]] and can be made by ingesting sodium nitrite<ref>Roueché, Berton (1953) Eleven blue men, and other narratives of medical detection. Boston: Little, Brown.</ref> as well as certain drugs and other chemicals{{which|date=August 2013}}.
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| ==Physiological compensation==
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| ===Acute===
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| If oxygen delivery to cells is insufficient for the demand (hypoxia), hydrogen will be shifted to [[pyruvic acid]] converting it to [[lactic acid]]. This temporary measure (anaerobic metabolism) allows small amounts of energy to be released. Lactic acid build up (in tissues and blood) is a sign of inadequate mitochondrial oxygenation, which may be due to hypoxemia, poor blood flow (e.g., shock) or a combination of both.<ref>{{cite journal | last=Hobler |first=K.E. |coauthors=L.C. Carey | title=Effect of acute progressive hypoxemia on cardiac output and plasma excess lactate | journal=Ann Surg | year=1973 | pages=199–202 | volume=177 | issue=2 | pmid= 4572785 | doi = 10.1097/00000658-197302000-00013 | pmc=1355564}}</ref> If severe or prolonged it could lead to cell death. {{Citation needed|date=August 2013}}
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| In humans, hypoxia is detected by chemoreceptors in the [[carotid body]]. This response does not control ventilation rate at normal p{{chem|O|2}}, but below normal the activity of neurons innervating these receptors increases dramatically, so much so to override the signals from central chemoreceptors in the [[hypothalamus]], increasing p{{chem|O|2}} despite a falling p{{CO2}}
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| In most tissues of the body, the response to hypoxia is [[vasodilation]]. By widening the blood vessels, the tissue allows greater perfusion.
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| By contrast, in the [[lungs]], the response to hypoxia is [[vasoconstriction]]. This is known as "[[Hypoxic pulmonary vasoconstriction]]", or "HPV". {{Citation needed|date=August 2013}}
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| ===Chronic===
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| {{expand section|date=August 2013}}
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| ==Treatment==
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| To counter the effects of high-altitude diseases, the body must return arterial p{{chem|O|2}} toward normal. [[Acclimatization]], the means by which the body adapts to higher altitudes, only partially restores p{{chem|O|2}} to standard levels. [[Hyperventilation]], the body’s most common response to high-altitude conditions, increases alveolar p{{chem|O|2}} by raising the depth and rate of breathing. However, while p{{chem|O|2}} does improve with hyperventilation, it does not return to normal. Studies of miners and astronomers working at 3000 meters and above show improved alveolar p{{chem|O|2}} with full acclimatization, yet the p{{chem|O|2}} level remains equal to or even below the threshold for continuous oxygen therapy for patients with [[chronic obstructive pulmonary disease]] (COPD).<ref name="West 2004 789–800">{{cite journal |last=West |first=John B. |year=2004 |title=The Physiologic Basis of High-Altitude Diseases |journal=Annals of Internal Medicine |volume=141 |pages=789–800 |issue=10 |pmid=15545679 |author2=American College Of Physicians |author3=American Physiological Society}}</ref> In addition, there are complications involved with acclimatization. [[Polycythemia]], in which the body increases the number of red blood cells in circulation, thickens the blood, raising the danger that the heart can’t pump it.
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| In high-altitude conditions, only oxygen enrichment can counteract the effects of hypoxia. By increasing the concentration of oxygen in the air, the effects of lower barometric pressure are countered and the level of arterial p{{chem|O|2}} is restored toward normal capacity. A small amount of supplemental oxygen reduces the equivalent altitude in climate-controlled rooms. At 4000 m, raising the oxygen concentration level by 5 percent via an oxygen concentrator and an existing ventilation system provides an altitude equivalent of 3000 m, which is much more tolerable for the increasing number of low-landers who work in high altitude.<ref>{{cite journal |last=West |first=John B. |year=1995 |title=Oxygen Enrichment of Room Air to Relieve the Hypoxia of High Altitude |journal=Respiration Physiology |volume=99 |pages=225–32 | doi = 10.1016/0034-5687(94)00094-G |issue=2 |pmid=7777705}}</ref> In a study of astronomers working in Chile at 5050 m, oxygen concentrators increased the level of oxygen concentration by almost 30 percent (that is, from 21 percent to 27 percent). This resulted in increased worker productivity, less fatigue, and improved sleep.<ref name="West 2004 789–800"/>
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| [[Oxygen concentrator]]s are uniquely suited for this purpose. They require little maintenance and electricity, provide a constant source of oxygen, and eliminate the expensive, and often dangerous, task of transporting oxygen cylinders to remote areas. Offices and housing already have climate-controlled rooms, in which temperature and humidity are kept at a constant level. Oxygen can be added to this system easily and relatively cheaply. {{Citation needed|date=August 2013}}
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| ==See also==
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| {{portal|Underwater diving}}
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| * [[Anoxia (disambiguation)]]
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| * [[Asphyxia]]
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| * [[G-LOC]] cerebral hypoxia induced by excessive g-forces
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| * [[Hypoxia (disambiguation)]] subsidiary articles e.g. [[Intrauterine hypoxia]].
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| * [[Hypoxic tumor]]
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| * [[Hypoxicator]] a device intended for hypoxia acclimatisation in a controlled manner
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| * [[Hyperoxia]]
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| * [[Sleep apnea]]
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| * [[Intermittent hypoxic training]]
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| * [[Hypoventilation training]]
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| * [[Time of useful consciousness]]
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| For aircraft decompression incidents at altitude see:
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| * [[1999 South Dakota Learjet crash]] (the crash which claimed the life of golfer [[Payne Stewart]])
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| * [[2000 Australia Beechcraft King Air crash]]
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| * [[Helios Flight 522]]
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| * [[Uncontrolled decompression#Notable decompression accidents and incidents|Notable decompression accidents and incidents]]
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| * [[Soyuz 11]] fatal spacecraft decompression on re-entry
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| == References ==
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| {{reflist}}
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| {{Respiratory physiology}}
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| {{Consequences of external causes}}
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| {{Diving medicine, physiology and physics}}
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| {{DEFAULTSORT:Hypoxia (Medical)}}
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| [[Category:Aviation medicine]]
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| [[Category:Diving medicine]]
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| [[Category:Mountaineering and health]]
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| [[Category:Oxygen]]
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| [[Category:Pulmonology]]
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