AKLIMATISASI

1 atm : -- cmHg : --- mmHg

Udara gas-gas (?)
Kadar O2 di alam udara : --%
Tekanan O2 (pO2) udara alveolus : ---
mmHg
 Breathing Air Breathing Pure Oxygen
Arterial Arterial
Barometric Po2 in Pco2 in Po2 in Pco2 in Po2 in
Altitude Oxygen Oxygen
Pressure Air Alveoli Alveoli Alveoli Alveoli
(ft) Saturation Saturation
(mmHg) (mmHg) (mm Hg) (mm Hg) (mm Hg) (mm Hg)
(%) (%)

0 760 159 40 (40) 104 (104) 97 (97) 40 673 100

10,000 523 110 36 (23) 67 (77) 90 (92) 40 436 100

20,000 349 73 24 (10) 40 (53) 73 (85) 40 262 100

30,000 226 47 24 (7) 18 (30) 24 (38) 40 139 99

40,000 141 29 36 58 84

50,000 87 18 24 16 15

Table Effects of Acute Exposure to Low Atmospheric Pressures on Alveolar

Gas Concentrations and Arterial Oxygen Saturation*
Figure. Composition of alveolar air in individuals breathing air (0-6100 m) and 100% O2 (6100-13,700 m). The minimal
alveolar PO2 that an unacclimatized subject can tolerate without loss of consciousness is about 35-40 mm Hg. Note that
with increasing altitude, the alveolar PCO2 drops because of the hyperventilation due to hypoxic stimulation of the carotid
and aortic chemoreceptors. The fall in barometric pressure with increasing altitude is not linear, because air is compressible.
HYPOXIA
Hypoxia is O2 deficiency at the tissue level.
Traditionally, hypoxia has been divided into
four types.
1. hypoxic hypoxia (anoxic anoxia),
2. anemic hypoxia,
3. stagnant or ischemic hypoxia,
4. histotoxic hypoxia,
Acute Effect of Hypoxia
The effects of hypoxia depend upon the tissue affected.
In hypoxic hypoxia and the other generalized forms of
hypoxia, the brain is affected first.
A sudden drop in the inspired PO2 to less than 20 mm Hg,
which occurs, causes loss of consciousness in 10-20 seconds
and death in 4-5 minutes.
Less severe hypoxia causes a variety of mental aberrations:
impaired judgment, drowsiness, dulled pain sensibility,
excitement, disorientation, loss of time sense, and headache.
Other symptoms include anorexia, nausea, vomiting,
tachycardia, and, when the hypoxia is severe, hypertension.
The rate of ventilation is increased in proportion to the
severity of the hypoxia of the carotid chemoreceptor cells.
Acute Mountain Sickness
A small percentage of people who ascend rapidly
to high altitudes become acutely sick and can die
if not given oxygen or removed to a low altitude.
The sickness begins from a few hours up to
about 2 days after ascent.
Two events frequently occur:
Acute cerebral edema.
Acute pulmonary edema.
Individuals who do not develop mountain
sickness have a diuresis at high altitude, and
urine volume is decreased in individuals who
develop the condition.
Chronic Mountain Sickness
Occasionally, a person who remains at
high altitude too long develops chronic
mountain sickness, in which the following
effects occur:
1) polycythemia
2) Elevation of the pulmonary arterial pressure
3) Enlargement of the right side of the heart
4) Falling of the peripheral arterial pressure
5) congestive heart failure ensues, and
6) Death.
Acclimatization
Acclimatization to altitude is due to the
operation of a variety of compensatory
mechanisms.
The principal means by which
acclimatization comes about are
1. a great increase in pulmonary ventilation,
2. increased numbers of red blood cells,
3. increased diffusing capacity of the lungs,
4. increased vascularity of the peripheral tissues,
5. increased ability of the tissue cells to use
oxygen despite low pO2
Table Potential problems associated with exposure
to increased barometric pressure.
Lung damage
Oxygen toxicity
Convulsions
Euphoria
Nitrogen narcosis
Impaired performance
High-pressure nervous Tremors
syndrome Somnolence
Pain
Decompression sickness
Paralyses
Air embolism Sudden death
Oxygen Therapy
Administration of oxygen-rich gas mixtures is of
great benefit in hypoxic hypoxia.
Treatment regimes that deliver less than 100% O 2
are of value both acutely and chronically, and
administration of O2 24 hours per day for 2 years
has been shown to significantly decrease the
mortality of chronic obstructive pulmonary
disease.
When 100% O2 is first inhaled, there may be a
slight decrease in respiration in normal individuals.
O2 therapy in hypercapnic patients in severe
pulmonary failure must be started with care.
Hyperbaric O 2 Therapy
exposure to 100% O2 at 2-3 atmospheres limited
to 5 hours or less seems not showing O2 toxicity.
Use in:
carbon monoxide poisoning,
radiation-induced tissue injury,
gas gangrene,
very severe blood loss anemia,
diabetic leg ulcers and other wounds that are slow to
heal,
rescue of skin flaps and grafts in which the circulation
is marginal.
the primary treatment for decompression sickness and
air embolism
Oxygen Toxicity
The extremely high tissue pO2 that occurs when oxygen is
breathed at very high alveolar oxygen pressure can be
detrimental to many of the body's tissues. For instance,
breathing oxygen at 4 atmospheres pressure of oxygen (pO2
= 3040 mm Hg) will cause brain seizures followed by coma in
most people within 30 to 60 minutes. The seizures often
occur without warning and, for obvious reasons, are likely to
be lethal to divers submerged beneath the sea.
Other symptoms encountered in acute oxygen poisoning
include nausea, muscle twitching, dizziness, disturbances of
vision, irritability, and disorientation. Exercise greatly increases
the diver's susceptibility to oxygen toxicity, causing symptoms
to appear much earlier and with far greater severity than in
the resting person.
Excessive Intracellular Oxidation as a Cause of Nervous
System Oxygen Toxicity-"Oxidizing Free Radicals."
Hypercapnia
Retention of CO2 in the body (hypercapnia)
initially stimulates respiration.
Retention of larger amounts produces
symptoms due to depression of the central
nervous system: confusion, diminished
sensory acuity, and, eventually, coma with
respiratory depression and death.
PCO2 is markedly elevated, there is severe
respiratory acidosis, and the plasma HCO3-
may exceed 40 meq/L.
Hypocapnia
Hypocapnia is the result of
hyperventilation.
Cerebral blood flow may be reduced 30%
or more.
The cerebral ischemia causes light-
headedness, dizziness, and paresthesias.