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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].

Fever
  • […] toxicity Poisoning by exhaust gas in aircraft Poisoning by exhaust gases on board watercraft Poisoning due to crowd control gas Poisoning due to irritant gas Poisoning due to mustard gas Poisoning due to nerve gas Poisoning due to vesicant gas Polymer fume fever[icd9data.com]
  • Ask others to avoid contact with your baby if they have a cold or fever, or ask them to wear a mask. Be aware that kissing your baby can spread RSV. Try to keep young children away from your baby.[nlm.nih.gov]
  • Some patients complain of nasal congestion or (perhaps similarly-caused ear clogging, congestion, and pain, perhaps caused by swelling of the mucous membranes On 24 hour exposure to 100% oxygen additional medical symptoms include the development of fever[inspectapedia.com]
  • In general, you shouldn't receive HBOT if you: Have certain types of lung diseases, because of an increased risk for a collapsed lung Have a collapsed lung Have a cold or a fever Have had recent ear surgery or injury Do not like small enclosed spaces[hopkinsmedicine.org]
  • The presence of a fever or a history of seizure is a relative contraindication to hyperbaric oxygen treatment.[en.wikipedia.org]
Weakness
  • […] say a medical patient undergoing hyperbaric treatment at high levels of oxygen and at increased pressure) is breathes 100% oxygen for more than a day (24 hours) s/he may show the symptoms we listed just above, and also the following: General physical weakness[inspectapedia.com]
  • Symptoms include nausea, headache, weakness, clumsiness, and confusion. Severe cases of carbon monoxide poisoning can cause seizures, loss of consciousness, or coma. Diagnosis is with a blood test.[merckmanuals.com]
  • Donald's case for keeping the exposure limits the same for both 100 percent oxygen and nitrox diving has weaknesses and should not be accepted as proven. Dr.[diversalertnetwork.org]
Rigor
  • Although rigorous statistical analysis is not yet complete, the trend is that Nitrox is a safe, easily handled mix when used by properly trained divers.[mindspring.com]
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]
Italian
  • Italian divers wearing 100 percent oxygen rebreathers, drove a torpedo close into a ship. While submerged to avoid detection, they detached its warhead under the ship's hull, and beat a hasty retreat after a timer was set.[diversalertnetwork.org]
Nasal Congestion
  • congestion or (perhaps similarly-caused ear clogging, congestion, and pain, perhaps caused by swelling of the mucous membranes On 24 hour exposure to 100% oxygen additional medical symptoms include the development of fever, nausea and vomiting, and a[inspectapedia.com]
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]
Nausea
  • […] more adverse effect on subsequent excursions than will 20 fsw; a return to 20 fsw for periods of 95-110 min seems to provide an adequate recovery period from an earlier excursion and enables a second excursion to be taken without additional hazard; nausea[ncbi.nlm.nih.gov]
  • Continuation of exposure can lead to vertigo and nausea followed by altered behaviour, clumsiness, and finally convulsions. The convulsions are usually tonic-clonic, and the patient has no memory of the crisis4,8.[inspectapedia.com]
  • Symptoms include nausea, headache, weakness, clumsiness, and confusion. Severe cases of carbon monoxide poisoning can cause seizures, loss of consciousness, or coma. Diagnosis is with a blood test.[merckmanuals.com]
Loss of Appetite
  • […] of appetite Experts also cite the obvious hazard of freezing-burns if someone comes in contact with liquid oxygen.[inspectapedia.com]
Mouth Breathing
Loss of Peripheral Vision
  • The loss of peripheral vision and myopia are reversible, while cataracts are a delayed complication.[symptoma.com]
Aphasia
  • Definite: muscle twitching, tinnitus (ringing in the ears), blurred or tunnel vision, disorientation, aphasia (inability to express oneself by speaking), nystagmus (rapid side-to-side motions of the eye), or incoordination.[diversalertnetwork.org]
Nystagmus
  • Definite: muscle twitching, tinnitus (ringing in the ears), blurred or tunnel vision, disorientation, aphasia (inability to express oneself by speaking), nystagmus (rapid side-to-side motions of the eye), or incoordination.[diversalertnetwork.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].

Pulmonary Infiltrate
  • infiltrates and clinical deterioration; although the mechanism for development of the condition is obscure, a disruption of enzymatic activity is likely, perhaps as a result of free radical formation.[medical-dictionary.thefreedictionary.com]
Candida
  • View Article PubMed Google Scholar Cairney WJ: Effect of hyperbaric oxygen on certain growth features of Candida albicans. Aviat Space Environ Med. 1978, 49: 956-958.[doi.org]

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]

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]

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]
  • 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]
  • Prevention of ROP Systemic steroids given immediately before preterm birth have been shown to reduce the incidence of respiratory distress syndrome (RDS) which may in turn prevent the development and severity of ROP.[cehjournal.org]
  • These preventive measures may help reduce infants' risk of respiratory distress syndrome (RDS), which can lead to BPD.[nhlbi.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: 2019-06-28 12:02