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KLowe Anesthesia Physiology 1: Respiratory > Lecture 5: Transport Of Oxygen And Carbon Dioxide > Flashcards

Lecture 5: Transport Of Oxygen And Carbon Dioxide Flashcards

1
Q

What is tissue oxygenation?

A

Process of moving O2 and CO2 in and out of body tissues

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2
Q

Diffusion is too slow for distances > than ___

A

100 micrometers

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3
Q

What are four types of hypoxia?

A
  • Hypoxic hypoxia
  • Stagnant (ischemic) hypoxia
  • Anemic hypoxic
  • Histotoxic hypoxia
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4
Q

Hypoxic hypoxia

A
  • Inadequate O2 uptake into blood in lungs

- COPD

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5
Q

Stagnant (ischemic) hypoxia

A
  • Inadequate blood flow to an organ

- Arteriosclerosis, PVD

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6
Q

Anemic hypoxia

A
  • Inadequate blood oxygen carrying capacity

- Inactivated hemoglobin

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7
Q

Histotoxic hypoxia

A
  • Interference with mitochondrial respiration

- Cyanide poisoning

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8
Q

Hypoxic hypoxia =

A

Low PO2 (because blood can’t take it up in the lungs)

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9
Q

Anemic hypoxia =

A

Low hemoglobin

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10
Q

Ischemic hypoxia =

A

Low perfusion (to an organ)

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11
Q

Cytotoxic hypoxia =

A

Cells can’t utilize O2

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12
Q

What is O2 carried by?

A

Red blood cells (erythrocytes)—hemoglobin (Hb)

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13
Q

What is normal hemoglobin concentration?

A

150 g/L or 15 g/dL

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14
Q

Hemoglobin carries ___ times more O2 than plasma

A

65 times more

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15
Q

Plasma has a ___ capacity to carry or transport O2

A

Low

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16
Q

___ amount of O2 dissolved in solution (plasma)

A

Small

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17
Q

Hemoglobin is a ___

A

Oxygen carrier protein

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18
Q

Subunits in hemoglobin

A
  • 2 alpha

- 2 beta

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19
Q

How many heme groups in hemoglobin?

A

4

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20
Q

Only ___ can bind O2

A

Fe2+

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21
Q

Molecular weight of hemoglobin is ___

A

64,000

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22
Q

Each gram of hemoglobin can carry up to ___ ml of O2

A

1.31 ml of O2, theoretically up to 1.39 ml/gm

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23
Q

Hemoglobin is the ___ form

A

Unoxygenated

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24
Q

Oxyhemoglobin is when ___ is combined

A

O2

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25
Q

Very ___ coordination bonds between Fe2+ and O2

A

Loose—easily reversible

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26
Q

Oxygen is carried in its ___ state, not ___

A

Molecular (O2) state, not ionic O2-

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27
Q

The oxyhemoglobin curve is ___ shaped

A

Sigmoid

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28
Q

How many oxygen molecules can bind to one hemoglobin (Hb)?

A

Up to 4 oxygen molecules

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29
Q

What is oxygen saturation?

A

The ratio of oxygen bound to hemoglobin compared to the total amount that can be bound

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30
Q

What is oxygen capacity?

A

Maximal amount of O2 bound to hemoglobin

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31
Q

Sat 100 = PaO2 ___

A

100+

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32
Q

Sat 95 = PaO2 ___

A

75

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33
Q

Sat 90 = PaO2 ___

A

60

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34
Q

Sat 75 = PaO2 ___

A

40 (mixed venous blood in pulmonary artery)

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35
Q

Sat 60 = PaO2 ___

A

30

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36
Q

Sat 50 = PaO2 ___

A

27 (Hb P50 point)

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37
Q

Very rough rule—PaO2 40,50,60 for Sat ___

A

70, 80, 90

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38
Q

P50 of Hb =

A

PaO2 27

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39
Q

What are ligands of hemoglobin?

A

Form covalent bonds to the ferrous iron in hemoglobin

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40
Q

The covalent bonds of ligands have ___ affinity to iron than oxygen

A

More affinity

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41
Q

Oxygen binds ___ to hemoglobin

A

Weakly

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42
Q

Two types of ligands of hemoglobin:

A
  • Carbon monoxide

- Nitric oxide

43
Q

Carbon monoxide has ___ times the affinity of oxygen for hemoglobin

A

250 times

  • Does not dissociate readily
  • Requires hours to rid body of CO
44
Q

Nitric oxide binds to Hb ___ times more strongly than oxygen

A

200,000 times

45
Q

Hemoglobin binds ___ to NO

A

Irreversibly

46
Q

Nitric oxide is used to treat ___

A

Pulmonary hypertension

47
Q

The hemoglobin-oxygen equilibrium curve shows the relationship between ___ and ___

A

Hemoglobin oxygen concentration and oxygen partial pressure

48
Q

What is the shape of the hemoglobin-oxygen equilibrium curve?

A

Sigmoid also shape

49
Q

P50 is the PO2 when hemoglobin is ___ saturated

A

50%

50
Q

P50 of Hb = PO2 of ___

A

27 mm Hg

51
Q

How is the hemoglobin-oxygen equilibrium curve affected? (2 ways)

A
  • Shift in position

- Change in shape

52
Q

What indicates a greater interference with O2 transport—change in shape or curve shift?

A

Change in shape

53
Q

Increased O2 affinity = shift to the ___

A

Left

54
Q

Examples of increased affinity (7)

A
  • Acute alkalosis
  • Decreased PCO2
  • Decreased temperature
  • Low levels of 2,3 DPG
  • Carboxyhemoglobin
  • Methemoglobin
  • Abnormal hemoglobin
55
Q

Decreased O2 affinity = shift to the ___

A

Right

56
Q

Examples of decreased affinity (5)

A
  • Acute acidosis
  • High CO2
  • Increased temperature
  • High levels of 2,3 DPG
  • Abnormal hemoglobin
57
Q

Shift to the right reduces the affinity for O2 below PO2 ___ mm Hg

A

70 mm Hg

58
Q

Shift to the right occurs because of ___ PCO2 and ___ ions

A

Rising PCO2 and rising H+ ions

59
Q

What is the Bohr effect?

A

An increase in H+ decreases Hb’s affinity for O2

60
Q

A shift to the right enhances the quantity of…

A

O2 released in systemic capillaries

61
Q

A shift to the right increases ___ of O2 to ___

A

Delivery of O2 to tissues

62
Q

Right shift = Hb has ___ affinity for O2, ___ O2, saturation will be ___ for a given PO2

A

Hb has less affinity for O2, releases O2, saturation will be less for a given PO2

63
Q

Left shift = Hb has ___ affinity for O2, ___ O2, saturation will be ___ for a given PO2

A

Hb has higher affinity for O2, binds O2, saturation will be higher for a given PO2

64
Q

Increased CO2 = shift to the ___

A

Right

65
Q

Increased temperature = shift to the ___

A

Right

66
Q

Increased metabolism = shift to the ___

A

Right

67
Q

Increase H+ = shift to the ___

A

Right (Bohr Effect)

68
Q

Acidosis/lactic acid production = shift to the ___

A

Right

69
Q

Increased 2,3 DPG = shift to the ___

A

Right

-2,3 DPG binds to Hb over O2, thus decreases Hb’s affinity for O2

70
Q

PRBCs are stored ___

A

Cold

71
Q

PRBCs have significantly ___ levels of 2,3 DPG

A

Diminished

72
Q

Hb in stored blood would initially show a ___ shift in the Hb-O2 dissociation curve

A

Left shift

73
Q

What is myoglobin?

A

Single chained heme pigment found in skeletal muscle

74
Q

Myoglobin has an ___ affinity for O2

A

Increased—binds O2 at a lower PO2

75
Q

Myoglobin stores O2 temporarily in ___

A

Muscle

76
Q

What does CaO2 stand for?

A

O2 content in blood

77
Q

What does CaO2 measure?

A

The sum of O2 carried on Hb AND dissolved in plasma

78
Q

How to calculate CaO2:

A

CaO2 = (SO2 x [Hb] x 1.31) + (PO2 x 0.003)

79
Q

CaO2 =

A

O2 content in blood (ml/dL)

80
Q

SO2 =

A

Hb saturation (can use SPO2–pulse ox. Or SaO2–saturation from blood gas (ABG), as a %)

81
Q

[Hb] =

A

Hb concentration in gm/dL

82
Q

1.31 =

A

O2 binding to Hb (ml/gm)

83
Q

PO2 =

A

Arterial blood’s partial pressure of O2

84
Q

What does DO2 stand for?

A

Oxygen delivery

85
Q

How do you calculate DO2?

A

DO2 = CaO2 x CO (cardiac output)

86
Q

What can alter the equilibrium curve?

A

Any factors that reduce Hb’s ability to transport O2

87
Q

What are two things that can reduce Hb’s ability to transport O2?

A
  • CO

- Anemia

88
Q

CO ___ the available Hb able to transport O2

A

Reduces

89
Q

Anemia

A
  • Decrease in hemoglobin

- Decreases O2 content in blood

90
Q

Tissue PCO2 is ___ mm Hg

A

50 mm Hg

91
Q

Carbonic acid is converted to ___ to be exhaled in the lungs

A

CO2

92
Q

CO2 production averages ___ ml/min in resting adult

A

200 ml/min

93
Q

During exercise, CO2 production may increase ___

A

Six-fold

94
Q

___ amount of CO2 remains in blood and is required in maintenance of the ___

A

High amount, maintenance in hydrogen ion concentration

95
Q

Carbon dioxide is transported by blood in three forms:

A
  • Dissolved directly in blood
  • Bicarbonate ion (HCO3-) and carbonic acid (H2CO3)
  • Bound to hemoglobin and plasma proteins
96
Q

Most CO2 is ___ for transport

A

Dissolved directly in the blood

97
Q

How is the HbCO2 curve different than the HbO2 curve? (2)

A
  • Relationship is linear

- Venous blood transports more CO2 than arterial blood

98
Q

CO2 equilibrium is affected by ___

A

O2 saturation of Hb

99
Q

Ability to bind with CO2 is increased in ___ Hb

A

Deoxygenated Hb

100
Q

Deoxygenated Hb is a ___ than oxygenated Hb

A

Weaker acid

101
Q

Haldane effect = upon binding O2, Hb releases ___ and ___, which in turn is converted into ___

A

Releases CO2 and H+, converted into CO2

102
Q

A-a PCO2 levels are not as affected by ___

A

V/Q mismatch

103
Q

Why are A-a PCO2 levels not as affected by V/Q mismatch?

A

Because the diffusing capacity of CO2 is 20x’s greater than that of O2

KLowe Anesthesia Physiology 1: Respiratory (13 decks)

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