Ch2 Cell Injury EC Flashcards
Pulse oximetry use and limitation
Measures oxygen saturation (SaO2)
Falsely increased SaO2 in metHb and COHb
What can be used to measure SaO2 with metHb or COHb?
Co-oximeter (not pulse ox)
What are the clinical findings in hypoxia?
Cyanosis
Confusion
Cognitive impairment
Lethargy
Ischemia
Decreased arterial blood inflow and/or venous outflow
What are the consequences of ischemia?
Atrophy
Infarction
Dysfunction
Hypoxemia
Decrease PaO2
If PACO2 increases, what happens to PAO2
It must decrease in order for the sum of partial pressures to remain equal (assuming N2 is constant)
What are the causes of hypoxia?
Ischemia (MCC, ie thrombus)
Hypoxemia (
What are the causes of hypoxemia?
Respiratory acidosis (increased CO2 means O2 must go down) Ventilation defects (ie respiratory distress syndrome) Perfusion defects (ie PE) Diffusion defect (ie sarcoidosis)
Define anemia
Decrease [Hb] (and thus O2 content)
What happens to pO2 levels and O2 saturation in anemia?
NOTHING!
There is no hypoxemia in anemia
Describe the conversion of methemoglobin to the ferrous state.
NADH reductase system
Electrons from NADH transferred to CYTOCHROME B5 then to metHb by CYTOCHROME B5 REDUCTASE yielding FE2+
What are the causes of methemoglobinemia?
Oxidant stress (drugs, sepsis) Congenital deficiency of cytochrome B5 reductase
How does methylene blue treat methemoglobinemia?
Accelerates the enzymatic reduction of MetHb by NADPH methemoglobin reductase (in PPP)
Clinical findings in methemoglobinemia
Cyanosis UNRESPONSIVE to O2
Chocolate-colored blood
What drugs commonly cause methemoglobinemia?
(same as for hemolytic anemia in G6PD) Dapsone Primaquine Nitroglycerine/Nitroprusside TMP-SMX ~common to see methemoglobinemia in AIDS b/c on TMP-SMX prophylaxis for PCP
Clinical findings in CO poisoning
Headache (most common symptom)
Cherry red discoloration
Dizziness
Seizures/Coma
Why don’t you see cyanosis in CO poisoning?
Masked by cherry red discoloration
Treatment for CO poisoning
100% oxygen
Response to high altitude
Hypoxemia stimulates peripheral chemoreceptors which leads to hyperventilation
Respiratory alkalosis increases intracellular pH which activates PFK (increasing glycolysis)
Increased production of of 2,3DPG by mutase reaction
OBC shifts to R
What is the function of the BCL-2 gene?
Prevents cytochrome C from leaving the ETC by maintaining the integrity of the mitochondrial membrane.
(If cytochrome C enters the cytosol, caspases are activated –> apoptosis)
How do CO and CN affect the ETC?
Inhibit CYTOCHROME OXIDASE in complex IV (cannot consume O2)
PaO2, SaO2, OBC, and Cytochrome oxidase in Anemia
PaO2=Normal
SaO2=Normal
OBC=Normal
Cytochrome Oxidase=Normal
PaO2, SaO2, OBC, and Cytochrome oxidase in CO poisoning
PaO2=Normal
SaO2=Decreased
OBC=Left-shifted
Cytochrome oxidase=Inhibited
PaO2, SaO2, OBC, and Cytochrome oxidase in Methemoglobinemia
PaO2=Normal
SaO2=Decreased
OBC=Left-Shifted
Cytochrome oxidase=Normal
PaO2, SaO2, OBC, and Cytochrome oxidase in CN poisoning
PaO2=Normal
SaO2=Normal
OBC=Normal
Cytochrome oxidase=Inhibited
Examples of uncoupling agents and MOA
Alcohol, Dinitrophenol, and Salicylates
Uncouple proton gradient across inner mitochondrial membrane (any rxn that makes NADH or FADH2 revs up –> hyperthermia)
Ischemic colitis
Watershed infarct at splenic flexure at junction of SMA/IMA
ST-segment depression ECG
Subendocardial ischemia
Nephron locations susceptible to hypoxia
Proximal tubule
Thick ascending limb