Anoxia

Definition

Anoxia is a condition characterized by an absence of oxygen supply to an organ or a tissue.

Description

Anoxia results when oxygen is not being delivered to a part of the body. If the condition does not involve total oxygen deprivation, it is often called hypoxia, although the two terms have been used interchangeably. A related condition, anoxemia, occurs when the blood circulates but contains a below normal amount of oxygen.


The five types of anoxia or hypoxia include hypoxemic, anemic, affinity, stagnant, and histotoxic. Hypoxemic anoxia happens when the oxygen pressure outside the body is so low that the hemoglobin, the chemical which carries oxygen in the red blood cells (RBCs), is unable to become fully loaded with the gas. This results in too little oxygen reaching the tissues and can occur in suffocation when a person is at high altitude, where the pressure of oxygen in the air is much less than at sea level.

Anemic anoxia results from a decrease in the amount of hemoglobin or RBCs in the blood, which reduces the ability to get oxygen to the tissues. Anemia may result from lack of production of red blood cells (iron deficiency), blood loss (hemorrhage), or shortened lifespan of red blood cells (autoimmune disease). Affinity anoxia involves a defect in the chemistry of the blood such that the hemoglobin can no longer pick up as much oxygen from the air, even though the quantities are normal, reducing how much is delivered to the tissues.

Stagnant anoxia occurs when there is interference with the blood flow, although the blood and its oxygen-carrying abilities are normal. A common cause of general stagnant anoxia is heart disease or interference with the return of blood flow through the veins. Examples of local stagnant anoxia include exposure to cold, diseases that restrict circulation to the extremities, and ergot poisoning. When the tissue or organ itself has a reduced ability to accept and use the oxygen, it is called histotoxic anoxia. The classic example is cyanide poisoning, where the chemical inactivates a cellular enzyme necessary for the cell to use oxygen. Thus, tissue exposed to cyanide cannot use the oxygen even though it is in normal amounts in the bloodstream. Histotoxic anoxia can also be caused by exposure to narcotics, alcohol, formaldehyde, acetone, toluene, and certain anesthetic agents.



Causes and symptoms

Anoxia and hypoxia can be caused by any number of disease states of the blood, lungs, heart and circulation including heart attack, severe asthma, or emphysema. It can also result from smoke or carbon monoxide inhalation, improper exposure to anesthesia, poisoning, strangulation, near-drowning, or high altitude exposure through mountain climbing or travel in an insufficiently pressurized airplane. Anoxia, and the resultant brain damage, is a particular problem with newborns during difficult births.

No matter what the cause of anoxia, the symptoms are similar. In severe cases, the patient is often confused and commonly stuperous or comatose (in a state of unconsciousness). Depending on the severity of the injury to the brain, the organ most sensitive to reduced oxygen intake, this condition can persist for hours, days, weeks, or even months or years. Seizures, myoclonic jerks (involuntary muscle spasms or twitches), and neck stiffness are some other symptoms of the anoxic condition.

Symptoms of more localized or less complete oxygen deprivation (hypoxia) include increased breathing rate, lightheadedness, dizziness, tingling or warm sensation, sweating, reduced field of vision, sleepiness, a bluish tint to skin, particularly the fingertips and lips, and behavior changes, often an inappropriate sense of euphoria.

Diagnosis

Diagnosis of anoxia and hypoxia is commonly made through the appearance of clinical symptoms. However, suspected reduction in oxygen reaching the tissues can be confirmed using laboratory tests. The exact test that is performed is dependent on the suspected cause of the anoxia. One systemic measure of tissue anoxia is the serumlactate (lactic acid) test. When cells are forced to produce energy without oxygen, as would happen during anoxia, lactic acid is one of the byproducts. Thus, an increase in lactic acid in the blood would indicate that tissues were starved for oxygen and are using non-oxygen pathways to produce energy. Normally, the blood contains less than 2 mmol/L of lactic acid. However, some forms of anoxia do not increase lactic acid concentrations in the blood and some increases in lactic acid levels are not associated with anoxia, so an elevated value for this test is only suggestive of an anoxic or hypoxic condition.

Treatment

The exact treatment for anoxia is dependent on the cause of the reduced oxygen reaching the tissues. However, immediate restoration of tissue oxygen levels through supplementing the patient's air supply with 100% oxygen is a common first step. Secondary steps often include support of the cardiovascular system through drugs or other treatment, treatment of lung disease, transfusions, or administration of anecdotes for poisoning, as appropriate.

Prognosis

A good prognosis is dependent on the ability to treat the underlying cause of the low oxygen levels. If cardiovascular and respiratory systems can be supported adequately, recovery from the injury to the tissue is possible, although extent of injury to the brain can be difficult to assess. The exact amount of recovery varies with the amount of injury sustained, where significant injury brings a poorer prognosis. As recovery occurs, both psychological and neurological abnormalities may appear, persist, and can improve. Some problems seen after anoxia include mental confusion, personality changes, amnesia or other types of memory loss, hallucinations, and persistent myoclonus (involuntary contractions of the muscles).

Prevention

Hypoxemic anoxia can be avoided by utilizing supplemental oxygen when in high altitudes and being aware of the early symptoms of altitude sickness and reducing altitude once recognized. Iron supplements can avoid anemic hypoxia, although more severe anemic states are usually caused by disease or bleeding. Maintaining good cardiovascular health through proper diet and exercise is a good first step to avoiding the most common cause of stagnant anoxia. Avoiding exposure to the toxic chemicals that cause the condition can prevent histotoxic anoxia.