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Oxygen Poisoning

When the partial pressure of oxygen in the circulation is abnormally high for a longer period of time, oxygen poisoning can develop. The lungs and the central nervous system are main sites where toxic effects are exerted. Manifestations range from mild symptoms to severe and life-threatening acute respiratory distress syndrome. Identifying exposure to high amounts of oxygen, clinical findings, arterial blood gas analysis, and pulmonary function tests are mandatory during workup.


Presentation

Despite its essential role in sustaining human life, oxygen can be highly toxic to humans under the circumstances of prolonged exposure to increased amounts of oxygen, which may be seen during hyperbaric oxygen therapy or in divers, who must inhale very large amounts of oxygen to sustain vital functions [1] [2] [3] [4]. Although many tissues have been reported as targets of oxygen toxicity, the two most important are the lungs and the central nervous system (CNS) [1] [4] [5]. The pathogenesis of tissue damage stems from accelerated formation of reactive oxygen species (ROS) in the presence of higher partial pressure of oxygen in the circulation. The CNS is particularly sensitive to these changes [1] [6]. Symptoms and signs of toxicity appear within few hours, most common being headaches, loss of consciousness, convulsions, and visual disturbances. The loss of peripheral vision and myopia are reversible, while cataracts are a delayed complication [1] [3]. On the other hand, respiratory manifestations such as carinal irritation, dyspnea, chest pain, an uncontrolled cough, tachypnea, and a sensation of choking are main indicators of lung-related oxygen poisoning [1] [3] [5]. Without cessation of exposure to high oxygen concentrations, pulmonary fibrosis, atelectasis, and acute respiratory distress syndrome (ARDS) may ensue [1] [5]. Neonates who suffered from oxygen poisoning could present with retinopathies, intraventricular hemorrhages, and chronic diseases of the lungs [1].

Increased Energy
  • Oxygen fans tout the benefits of oxygen as reducing stress , increasing energy and alertness, lessening the effects of hangovers, headaches, and sinus problems , and generally relaxing the body.[web.archive.org]
  • Claims have been made that this reduces stress, increases energy, and lessens the effects of hangovers and headaches, despite the lack of any scientific evidence to support them.[en.wikipedia.org]
Anorexia
  • The poisonous effects manifest themselves in drowsiness, anorexia, loss of weight, increasing dyspnea, cyanosis and death from oxygen want. 3. The cause of oxygen want is a destructive lesion of the lungs. 4.[jem.rupress.org]
Rales
  • Physical findings related to pulmonary toxicity have included bubbling sounds heard through a stethoscope (bubbling rales), fever, and increased blood flow to the lining of the nose (hyperaemia of the nasal mucosa).[en.wikipedia.org]

Workup

Timely cessation of exposure will result in complete resolution of symptoms [1] [5], but in the absence of an early diagnosis, consequences could be severe. For this reason, it is important to identify oxygen poisoning early on and establish the mode, as well as source of exposure in order to facilitate treatment. The physician must obtain a detailed patient history that will assess the presence of risk factors (eg. diving, hyperbaric oxygen therapy) and note the course and progression of symptoms, whereas physical examination, particularly lung auscultation, can detect crackles, rhonchi, or wheezing [5]. Laboratory investigation comprised of a complete blood count (CBC), serum electrolytes, but most importantly, arterial blood gas (ABG) analysis, should be performed as soon as possible, together with a chest X-ray that frequently shows findings consistent with bilateral pulmonary edema [5]. Spirometry is also a vital constituent of the diagnostic workup and many patients exhibit a reduction in the vital capacity (VC). The diffusing capacity for carbon monoxide and dynamic lung compliance are both reduced in certain cases [1].

Treatment

  • The risk for oxygen convulsions during routine hyperbaric treatment of most routine conditions is extremely low.[archive.rubicon-foundation.org]
  • For this reason, it is important to identify oxygen poisoning early on and establish the mode, as well as source of exposure in order to facilitate treatment.[symptoma.com]
  • Seizure incidence in 80,000 patient treatments with hyperbaric oxygen . Aviat Space Environ Med 2004; 75:992–994.[ingentaconnect.com]
  • Treatment for Bronchopulmonary Dysplasia Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection.[nhlbi.nih.gov]

Prognosis

  • Appreciate clinical and laboratory responses, need for other therapy and prognosis. Additional Objectives: Attend periodic patient follow-up visits. Determine degree of outcome complications and side-effects to hyperbaric oxygen therapy.[web.archive.org]

Etiology

  • Our results clearly demonstrate three novel points, which together provide a new perspective on the etiology of pulmonary injury in hyperbaric hyperoxia.[doi.org]

Pathophysiology

  • Thom , Saturation Diving; Physiology and Pathophysiology , Comprehensive Physiology , (1229-1272) , (2014) . James M.[doi.org]
  • The proven pathophysiologic profile of actions of hyperoxia set the basis for its use in selected clinical conditions.[doi.org]

Prevention

  • Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation.[books.google.com]
  • This is an issue for people who have lung disease and other ailments that prevent them from breathing properly without canisters of oxygen.[io9.com]
  • These preventive measures may help reduce infants' risk of respiratory distress syndrome (RDS), which can lead to BPD.[nhlbi.nih.gov]
  • To help prevent BPD: Prevent premature delivery whenever possible. If you are pregnant or thinking about getting pregnant, get prenatal care to help keep you and your baby healthy.[nlm.nih.gov]

References

Article

  1. Chawla A, Lavania A. Oxygen Toxicity. Med J Armed Forces India. 2001;57(2):131-133.
  2. Fock A, Harris R, Slade M. Oxygen exposure and toxicity in recreational technical divers. Diving Hyperb Med. 2013;43(2):67-71.
  3. Arieli R, Arieli Y, Daskalovic Y, Eynan M, Abramovich A. CNS oxygen toxicity in closed-circuit diving: signs and symptoms before loss of consciousness. Aviat Space Environ Med. 2006;77(11):1153-1157.
  4. Hampson N, Atik D. Central nervous system oxygen toxicity during routine hyperbaric oxygen therapy. Undersea Hyperb Med. 2003;30(2):147-153.
  5. Mach WJ, Thimmesch AR, Pierce JT, Pierce JD. Consequences of Hyperoxia and the Toxicity of Oxygen in the Lung. Nurs Res Pract. 2011;2011:260482.
  6. van Ooij PA, Sterk PJ, van Hulst RA. Oxygen, the lung and the diver: friends and foes? Eur Respir Rev. 2016;25(142):496-505.

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Last updated: 2017-08-09 16:13