Physiology / 2009-10 Dr. Ahmad .S.

Alarabi

Respiration

Definition: the respiration is the process of gas exchange (taking O2 & removing CO2).

• The respiration can be divided into:

1- External respiration: it is the process of gas exchange at the level of lung.

It is divided into:

• Pulmonary ventilation: movement of the gases into and out of lungs. It is achieved
by breathing movements [inspiration & expiration].

• Pulmonary respiration: it is the process of gas exchange between the alveoli &
pulmonary capillaries [by diffusion].

2- Respiratory function of blood: it is the process of transport of gases [O2 & CO2] from
the lungs into the tissues and, vice versa.

3- Internal (tissue) respiration: it is the oxidation of food materials in the cells by the
available O2 and the liberation of CO2 & energy.

Physiological anatomy of the

respiratory system

The respiratory system consists of:

• Airways & lungs

• Respiratory muscles
• Respiratory center

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

1- Airways & lungs: functionally, they are divided into:

a- Conducting zone: it includes [Nose / Mouth / Nasopharynx / Larynx / Bronchi /

Non-respiratory bronchioles]. It performs the following functions:

• Conditioning of inspired air to be at

body temperature.
• Humidification of air to protect the
air ways from desiccation.
• Filtration & trapping of entered
particles [e.g. dusts] by means of hairs
& mucous.
• Protection and keeping the airways
clear from foreign bodies by means of
reflexes [sneezing & coughing reflexes].
• Non respiratory functions [i.e. smell
(by nose) & phonation (by larynx)].

b- Respiratory zone: it includes [respiratory

bronchioles / alveolar ducts / alveoli].
This zone is suitable for gas exchange
because it has a thin respiratory membrane
[alveolus wall & pulmonary capillary wall]
with a 0.5 – 1 microns thickness and about 100 m2 surface area.

2- The respiratory muscles:

• Diaphragm: the main respiratory muscle [responsible for about 75% of respiration].
• External intercostal M: helps in the process of inspiration.
• Internal intercostal M: helps in the forced expiration.
• Abdominal wall M: help in the forced expiration.
• Accessory muscles of respiration: [sternocleidomastoid, serratus anterior, scalene,
pectoralis major, latissmus dorsi]. They help in forced inspiration.

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

• The functions of the respiratory system in general include:

1- Gas exchange.
2- Helps in maintaining homeostasis.
3- Production of some converting enzymes [will be discussed more in renal part].
4- Metabolism of various exogenous drugs.

Normal respiration and

lung mechanisms

• At rest, the human breath 12 – 15 times / min [about 500 ml / breath].

The respiratory cycle consists of 2 phases:

a- Inspiratory phase [active process].

b- Expiratory phase [passive process, takes longer time, followed by expiratory pause].

Mechanics of inspiration

• This process starts by sending impulses from the inspiratory center in the medulla
oblongata through the phrenic nerve to the muscles that are involved in inspiration.

• The mechanical action of inspiration starts by contraction of the diaphragm [the main
muscle], external intercostal muscles, and accessory muscle [only in forced inspiration].

• The contraction of diaphragm → ↑ vertical diameter of the chest while the

contraction of the external intercostals and accessory muscles & the relaxation of
abdominal wall muscles will lead to elevation of the thoracic cage [ribs & sternum] → ↑
lateral & anteroposterior diameter of the chest wall.

• The ↑ in both vertical, lateral, and anteroposterior diameter of the thoracic cage [in
the closed space of thoracic cavity] will leads to generation of negative pressure inside
this cavity.

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• The intra-thoracic [intra-pleural] negative pressure [which is about 1 – 3 mmHg below

the atmospheric pressure] will be transmitted into the intra-alveolar [intrapulmonary]
space. This will lead to inflow of air into the lungs [→ its distention] until the
intrapulmonary pressure equals the atmospheric pressure.

Mechanics of expiration

• This passive process starts when the diaphragm & external intercostals relax.

• This will lead to compression of the thoracic cavity which in addition to the
contraction of expiratory muscle [internal intercostals & abdominal wall] and the elastic
recoil of the lung → ↑ intra-thoracic pressure [and thus the intrapulmonary] to be a
positive pressure [1 – 3 mmHg above the atmospheric pressure].

• This positive pressure will push the air to out of the lung [expiration].

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Pressures & volumes

• Intra-pleural [intra-thoracic] pressure: it is the pressure in the space between the

two layers of the pleura [visceral & parietal]. It is always negative during normal
respiration [to prevent the collapse of the lungs]. During rest, It is about (– 5 cm H2O).

• Intrapulmonary [intra-alveolar] pressure: it is the pressure inside the alveoli

during the respiratory cycle. Its magnitude differs according to the phase:

Normal inspiration = [– 1 mmHg].

Normal expiration = [+ 1 mmHg].
Forced inspiration (closed glottis) = [– 80 mmHg].
Forced expiration = [+ 80 mmHg].

• Transmural pressure (TMP): it is the difference in pressure between the inside of

the alveolus and its outside [across the airway wall].

Lung volumes & capacities

• When we record the volume of air moving in and out of the lungs by spirometer, the
following changes will be plotted on the recording paper:

1- Tidal volume (TV): it is the volume of air inspired or expired during quite
breathing [about 500 ml/breath].

2- Inspiratory reserve volume (IRV): it is the volume of maximally inspired air after
the end of normal breathing [after inhaling the TV].

3- Expiratory reserve volume (ERV): it is the volume of maximally expired air after
the end of normal expiration [after exhaling the TV].

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4- Vital capacity (VC): it is the volume of air from maximal inhalation to maximal
exhalation. [i.e. VC = IRV + TV + ERV].

5- Residual volume (RV): the volume of air remaining in the lungs after maximal
expiration.

6- Inspiratory capacity (IC): IC = IRV + TV.

7- Functional residual capacity (FRC): FRC = ERV + RV.

8- Total lung capacity (TLC): TLC = VC + RV.

All the pulmonary volumes and capacities are:

• 25% less in females than in males.

• Greater in athletic people.
• Less in recumbent than in standing position.

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Lung compliance

Definition: It is the change in lung volume per each change in the transmural pressure.
• It is a measure of distensibility of the lungs and chest.

Compliance (C) = ∆V / ∆P.

Where [∆P = transmural P (intra-alveolar P – intra-pleural P)].

• The characteristic of compliance is determined by many factors:

1- Recoil of the lungs due to presence of elastic tissue [→ ↓ compliance].

2- Elastic force produced by surface tension of the fluid that lines the inside of alveoli.
3- Presence of surfactant [→ ↓ surface tension → ↑ compliance].
4- Elastic forces produced by the thoracic wall [→ ↓ compliance].

• The normal lung compliance (C L) = 200 ml / 1 cm. H2O.

That is mean, each 1 cm. H2O change in the transmural pressure (– ve pressure) will lead
distention of the lungs to receive 200 ml of inspired air.

• Chest wall compliance (C W): the forces exerted by chest wall to collapse the lung
are equal to the forces that tend to expand the chest wall. Thus, in normal man the
chest wall compliance is similar to the lung compliance.
(C W) = (C L) = 200 ml / cm.H2O.

• Total thoracic compliance (C tot): since the lungs and chest wall moving together, so
the C tot is calculated by the following formula:

1 / C tot = 1 / C L + 1 / C W = 1 / 200 + 1 / 200.

So, C tot = 100 ml / cm. H2O

• The lung compliance is decreased in [lung fibrosis, and increased in emphysema].

• The thoracic compliance is ↓ in [kyphoscoliosis, sk. Muscles disorder, & obesity].

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

Surfactant

Definition: it is a lipoprotein produced by type II alveolar cells.

It is a significant determinant factor for lung compliance.

• The fluids that line the alveolar wall exert a surface tension that tends to collapse the
alveoli. The presence of the surfactant leads to the decrease of this surface tension
thus increase the lung distensibility (compliance).

• The surfactant also prevents the development of pulmonary edema. This is because
the surface tension inside the alveolus leads to filtration (suction) of fluids from the
pulmonary capillaries into the alveolar cavity, the surfactant prevents the occurrence of
this by its decrease to the surface tension.

• The surfactant deficiency occurs in the following conditions:

• Respiratory distress syndrome: occurs in premature babies (6 – 7 months).

• Cardiac surgery.
• Long term inhalation of pure oxygen (100%).
• Occlusion of pulmonary artery or bronchus.

Pulmonary ventilation

• The ventilation of a region is the amount of air (gas) moved into or out of that region
irrespective to the initial volume of air.

• At rest, the normal person breath 12 – 15 times/minute [500 ml / breath].

Therefore, the pulmonary ventilation [minute respiratory volume] will be:

MRV = RR X TV = 12 X 500 = 6000 ml (6 liter) / minute.

• Alveolar ventilation: it is the volume of air that enters to the respiratory exchange
area [respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli] per minute.
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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

• The aim of this ventilation is to renew continually the air in the gas exchange area.

• Not all the air enters the respiratory system undergoes exchange; part of this air goes
to non respiratory parts [i.e. respiratory passages from the nose to the non-respiratory
bronchioles]. This space called Dead space.

• There are two dead spaces:

1- Anatomical dead space: it is the inspired air that does not reach [or mix with
air in] the respiratory exchange area.

2- Physiological dead space: the volume of inspired air did not take place in
the process of gas exchange [even if it was in the respiratory area].

• In normal person all the alveoli are functioning.

Where, the physiological d.sp [VD] = anatomical d.sp = 150 ml.

• So, the alveolar ventilation = (VT – VD) X respiratory rate (RR)

= (500 – 150) X 12 = 4200 ml/minute.

• The dead space can be affected by:

• Body size.
• Lung volume.
• Age.
• Sex.
• Physical training.

Effects of gravity on ventilation

In the upright position, the ventilation in the lower part of the lung is better than that of
the upper part of the lung [due to difference in intra-pleural pressure which makes the
alveoli in the top more distended than that in the base of the lung → ↓ their ability to
receive new air].

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

The pulmonary circulation

• About 10% of the total blood volume of the body is present in the lung at any time.

• The lungs are supplied by two arteries [2 Rt & 2 Lt]:

Pulmonary arteries (circulation): they originate from the Rt side of the heart.
They carry deoxygenated blood to the lung. There, these arteries form at their ends
pulmonary capillaries which change the gases with the alveoli. On the other hand, the
pulmonary veins carry oxygenated blood.

Bronchial arteries (circulation): they originate from the aorta. They carry
oxygenated blood to the supporting tissue of the lung.
After that, they drain their deoxygenated blood in the pulmonary veins.

• On the draining of the deoxygenated blood from the bronchial circulation into the
pulmonary circulation, this blood will dilute the oxygenated blood inside the pulmonary
veins, [i.e. about 2% of the pulmonary blood will be deoxygenated].
This will cause the so called (2% physiological shunt).

• The pulmonary arteries are larger and thinner than the systemic arteries.
The pressures in the pulmonary arteries are less than that in the systemic arteries
because of their lower resistance to blood flow.
So, the pulmonary circulation is high compliance low resistance system.

• This pressure remains low during exercise despite of the increased cardiac output, this
because:

1- Opening of the closed capillaries.

2- Distension of the opened capillaries in response to an increase in perfusion
pressure [because of their good distensibility (compliance)].

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

Regional distribution of blood flow

• The pulmonary blood is not uniformly distributed throughout the lung.

It is greater in the base than in the top of the lung. This is due to the different effects of
the following pressures which control the blood flow throughout the lung which are:

1- The hydrostatic pressure: it is the pressure inside the pulmonary capillaries due to
the weight of the blood column. It is the pressure that keeps the pulmonary capillaries
opened.
It in the capillaries of the lung base more is more than that in the capillaries of the top.

2- Arterio-venous pressure: it is the pressure difference between the arterial and

venous end of the pulmonary capillaries. This pressure can drive the blood from the
arterial to the venous end only when the hydrostatic pressure keeps them open.

3- Alveolar air pressure: it is close to atmospheric pressure.

If this pressure was greater than the hydrostatic pressure at certain level, it will lead to
squeezing of the pulmonary capillaries by the distended alveoli → closure of these
capillaries [this occurs at the top of the lung due to the effect of gravity (as discussed
before)].

• In the upright lung, there are 3 zones:

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

Zone (1): this zone occurs when breathing against high air pressure and in certain
respiratory diseases. In this zone [PA > Pa > Pv].

Zone (2): it is at the apex of the lung. In this zone [Pa > PA > Pv].

Zone (3): it is at the base of the lung. In this zone [Pa > Pv > PA].

• The pulmonary arterial systolic pressure = 24 – 28 mmHg.

• The pulmonary arterial diastolic pressure = 8 – 10 mmHg.

• The systolic pressure raises the blood column from the heart about 35 cm, while the
diastolic pressure raises it about 13 cm.

As being the apex of the lung about 15 cm above the heart level, thus the blood flows to
the apex only during systole.

Ventilation Perfusion ratio [VA : Q]

Both of ventilation and perfusion ↑ from apex to base of lung due to effect of gravity.
But as the Sp. Gravity of blood is > that of air, the increase will be in perfusion more
than in ventilation. This ration normally varies from 0.5 (Base) to 3 (Apex), and the
average V:Q in the normal lung of a resting subject is (0.8).

Diffusion of gases

The partial pressure of gas

The pressure exerted by a gas in a mixture of gases is equal to the total pressures of this
gas multiplied by the percentage (fraction) of this gas in the mixture [dalton’s law].

Pp = fraction X PB. Where Pp [partial pressure] & PB [barometric pressure].

Example: O2 form 21% of air. And the atmospheric pressure = 760 mmHg.
So, PO2 = 21% (0.21) X 760 = 160 mmHg at sea level.

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

Diffusion in gases medium

• The gases diffuse from area of high pressure to areas of low pressure [as happens
between atmospheric & alveolar air].

• The rate of diffusion of a gas is directly proportional to:

1- The pressure difference [∆ P (P1 – P2)].

2- Temperature.
3- Surface area.

And it is inversely proportional to:

1- Square root of the molecular weight (MW).

2- Thickness of the membrane.

Note: the diffusion rate for O2 is (1.2) times faster than CO2 [in gas state].
Therefore, O2 & CO2 diffuses with almost the same rate in alveolar gas.

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

The diffusion in liquid media

• In addition to the previous factors that determine the gas diffusion in gas media, it is
affected in a liquid media by the following:

1- Solubility of the gas in liquid.

2- Viscosity of the liquid.

• The solubility of CO2 in tissue fluid = 0.59 ml / mmHg / ml of fluid.

• The solubility of O2 in tissue fluid = 0.025 ml / mmHg / ml of fluid.

• Therefore, CO2 diffuses 23 times faster than O2 in the liquid media [e.g. pulmonary
membrane, plasma of erythrocyte, and vessel wall].

• The diffusion capacity of the lung is directly proportional to the alveolocapillary

membrane (surface area) and inversely proportional to the thickness of this membrane.

So, the diffusion capacity of the lung can be affected by:

• Edema (will increase the thickness of the membrane).

• Emphysema (decrease surface area for diffusion).

Composition of air

Air gas Atmospheric Alveolar Expired

% P % P % P
O2 20.84 159 13.6 104 15.7 120

CO2 0.04 0.3 5.3 40 3.6 27

N2 78.62 597 74.9 569 74.5 566

Water vapor 0.5 3.7 6.2 47 6.2 47

Total 100 % 760 100 % 760 100 % 760

[(%) is the percentage of gas in air composition; (P) is the pressure of gas (in mmHg)].

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

Notes:
• The % composition of air at sea level is the same at high altitude.
• The total pressure (barometric pressure) decreases at high altitude.
So, the partial pressure of oxygen at sea level is:
. ×
PO2 = = 158.38 = 159 mmHg.

But at 18000 feet above sea level is:

. ×
PO2 = = 79 mmHg.

Tension of gases in the body during rest (in mmHg)

Gas Venous blood Alveolar air Arterial blood Tissues

O2 40 104 95 40
CO2 46 40 40 46

From this table, we note that PO2 in the arterial blood is less than in the alveolar air
because:

1- Oxygen diffuses slower than carbon dioxide.

2- Mixing of the oxygenated blood by deoxygenated blood (physiological shunt 2%).

Arterial and venous contents of gases

Gas Arterial blood Venous blood

Dissolved 0.29 ml / dL 0.12 ml / dL
O2
Combined wit Hb 19.5 ml / dL 14.1 ml / dL
CO2 48 ml / dL 52 ml / dL

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

Gas transport between the

lungs and tissues

Oxygen transport

The oxygen delivery to the lungs is determined by many factors. One of these factors is
the capacity of the blood to carry oxygen which is 20%. This capacity is determined by:

a- Amount of O2 dissolved in the blood.

b- Amount of hemoglobin (Hb) in the blood [each gram of Hb can adapt (1.33) ml of O2].
c- Affinity of the Hb for oxygen.

• The oxygen carried in the blood is in 2 forms:

1- Dissolved in the water of plasma or water of RBCs [3%].

2- Chemical combination with Hb (oxyhemoglobin) [97%].

The oxygen hemoglobin

dissociation curve

• It is a sigmoid shaped curve that describes the affinity of Hb for O2 [i.e. describes the
relation between (the percentage of saturation of Hb by oxygen) & (PO2 in the blood)].

• This curve could be shifted to the right or to the left by many physiological factors.
• When the oxygen hemoglobin dissociation curve shifts to the right, that is mean a
higher PO2 is required for Hb to bind a given amount of O2.
This means that the affinity of Hb to O2 is ↓ (i.e. ↑ dissociation and liberation of O2
from the Hb → facilitate the delivery of oxygen to the tissues)].

• The factors that shift the curve to the right include:

1- ↓ PH [↑ H+ concentration (acidosis)].
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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

2- ↑ temperature.
3- ↑ PCO2 [at tissue level].
4- 2,3 Diphosphoglycerate
[formed in the RBC, and ↑
during exercise].

• On the other hand, when this

curve shift to the left, the opposite
will occur [↑ affinity of Hb to O2 →
↓ dissociation & liberation of
oxygen from Hb → binding of large
amount of O2 even at low PO2 level
(this occurs at the pulmonary
capillaries)].

The factors that shift this curve to the left include:

1- ↑ PH [↓ H+ concentration (alkalosis)].
2- ↓ temperature.
3- ↓ PCO2 (at pulmonary capillaries).
4- Presence of HbF [has more affinity for O2].
5- Presence of carboxy hemoglobin [COHb].

• The carbon monoxide (CO) combines with Hb to form COHb. The CO has affinity for Hb
about 210 – 240 times more than that of O2. Therefore, small amounts of CO can binds
large amount of Hb in the blood thereby making it unavailable for oxygen.

• When the CO bound with Hb it results in the following:

1- Total Hb concentration is normal.

2- PO2 is normal.
3- O2 content is reduced.
4- The COHb shifts the O2-Hb dissociation curve to the left.

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

• P50: it is the partial pressure of O2 required for the saturation of 50% of Hb with
oxygen.

Myoglobin: it is an iron containing pigment found in skeletal muscles. it binds with one
molecule of O2 rather than 4 molecules as in Hb.
It takes up O2 from the Hb in the blood and store it, then release it only at very low PO2
[as in exercise].

Transport of carbon dioxide

• The carbon dioxide is carried in the blood in the following forms:

1- Physically dissolved in the blood [about 10%].

2- As bicarbonate (HC3) [about 70%].
3- As carbonic acid [very little].
4- Combined with proteins in plasma [carbamino compounds].
5- Combined with Hb in RBCs [carbamino hemoglobin].

Bicarbonate

• The bicarbonate is formed in the blood as following:

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

CO2 + H2O H2CO3 H+ + HCO3 –

• The 1st reaction is fastened by the enzyme (carbonic anhydrase) which is present
inside the RBCs.

• Within the RBC, the formed bicarbonate diffuses outside into the plasma. The H+ can’t
diffuse outside. Instead, the chloride (Cl –) (negatively charged) diffuses into the RBC to
maintain the electroneutrality, this is called the chloride shift.

• The H+ ion inside the RBC is buffered by its binding to the oxyhemoglobin (HbO2)
and the deoxyhemoglobin (H.Hb) & O2 are formed:

(H+) + (HbO2) H.Hb + O2.

Notes:Although the total amount of CO2 carried by RBCs is less than that carried by
plasma, and as the reaction of CO2 and buffering of hydrogen is more in the RBCs, thus
the exchange of CO2 in the tissues and lungs depend more on the RBCs than on plasma.

Control of respiration

• The spontaneous respiration is produced by rhythmic impulses generated from motor

cells located in the upper Pons and lower medulla [respiratory center].
• The rate of these discharges is regulated by alteration in arterial PO2, PCO2, & H+
concentrations.

• The process of respiration is regulated by the respiratory center in the following way:

٠The respiratory center [apneustic center] discharges the motor neurons that
innervate the muscles employed in the inspiration process [drive the inspiratory
process].

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

٠When the lung expands due to inspiration, the stretch receptors in the lung relay
information to the respiratory center via the vagus nerve.
This will reflexely inhibits the inspiratory drive [which was taken by apneustic center]
and reinforce the action of pneumotaxic center to produce intermittency of inspiration.

٠If the pneumotaxic center was destroyed, or the vagal reflex is abolished [e.g. on
vagotomy], this will result in long maintained and powerful inspiratory effort
interspersed by short expirations.

Voluntary control of breathing

The person can control his breathing voluntarily by sending impulses from the cerebral
cortex [motor area] through a pathway that bypass the respiratory center.

Chemical control of breathing

• The ultimate goal of pulmonary ventilation is to maintain a proper concentration of
O2, CO2, and H+.

• The changes in the concentration of these 3 molecules are detected by sensory areas
called chemoreceptors. These receptors are of 2 types:

1- Central chemoreceptors: these receptors are located in the surface of the

medulla oblongata (MO).
٠The increase in PCO2 in the blood causes an increase in CO2 concentration in the CSF
[cerebrospinal fluid]. As being the CO2 can diffuse easily though the BBB [blood brain
barrier] while the H+ can’t diffuse through it; so, these receptors can be stimulated
only by an increase in CO2.
٠In general, the hypoxia [↓ PO2] does not affect the central chemoreceptors.

2- Peripheral chemoreceptors: they are located in the aortic and carotid bodies.
They are stimulated by the following:

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Physiology / 2009-10 Dr. Ahmad .S. Alarabi

a- Hypoxia [↓ PO2] [the main stimulator].

b- Acidosis [↑ in H+ concentration].
c- Hypercapnea [↑ PCO2] [stimulate it but less than its stimulation to central
chemoreceptors].

Hypoxia

Definition: an inadequate supply of oxygen to tissues. The decrease of oxygen in the

blood is called hypoxemia.

• Types of hypoxia:

1- Hypoxic hypoxia: it is caused by any condition that interferes with the proper
oxygenation of blood in the lungs like in cases of:

• Ascending to high altitude [↓ PAO2 → ↓ PaO2].

• Breathing air with low PO2.
• Arteriovenous shunt.

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2- Anemic hypoxia: this type is caused by decrease in the oxygen carrying capacity of
the blood.

It is caused by:

• Hemorrhage & anemia.

• CO poisoning [formation of carboxyhemoglobin].
++ +++
• Formation of methemoglobin or sulphahemoglobin [transfer of Fe → Fe ].

3- Stagnant hypoxia: it is caused by decrease in the rate of blood flow to tissues.

It is caused by:

• Congestive heart failure [left side].

• Raynaud’s disease [vasoconstriction in the hands and feet by cold].
• Hyperviscosity of the blood → ↓ blood flow [e.g. in polycythemia].

4- Histotoxic hypoxia: it is due to a defect in the oxidative enzymes of the cells that is
caused by poisons [e.g. KCN (potassium cyanide)]. In this case the venous blood
looks arterial because the cells are unable to utilize the oxygen.

Ventilation in high altitude

• Ascending to high altitude is accompanied with a decrease in barometric pressure →

↓PAO2 → ↓ PaO2. This decrease in PaO2 will stimulate the peripheral chemoreceptors
→ ↑ ventilation [hyperventilation]. This will cause:

1- Washout of carbon dioxide from the blood.

CO2 + H2O H2CO3 H+ + HCO3 –

This equation will be shifted to the left.

2- Decrease in H+ concentration [i.e. ↑ PH (alkalosis)].

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• After several days of ascending to high altitude, the body adapts to the new situation
and the respiration returns back to normal. Also the kidneys excrete HCO3- to keep the
H+ [blood PH] within normal.

• The other changes also include an increase in RBCs count [↑ Hb] and shifting of the
oxygen hemoglobin dissociation curve to the right.

Oxygen toxicity

The breathing of pure oxygen [oxygen 100%] at atmospheric pressure for a long period
is harmful. Its hazards include:

• Pulmonary edema [due to destruction of the endothelium of pulmonary

capillaries].
• Retinitis pigmentosa: a condition occurs when giving premature infant pure
oxygen. This O2 will cause local vasoconstriction in the retina → formation of
fibrous tissue → blindness.

Cyanosis

It is a bluish discoloration of the tissues when the reduced hemoglobin concentration in

the capillaries is > 5 gm / dL.

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