SEN BpdLoeall /[5jS pall ylaally pase las! dao! pulindline yoSull How the Oxygen reaches the cells? needs the following: - 1- External respiration. (Between lung & atmosphere). 2- Exchange between the alveoli &pulmonary circulation. 3- Transport of blood gases in the circulation. 4- Internal respiration, that's the exchange between blood & body cells. 5- Cellular respiration, that's inside the mitochondria for ATP liberation. What is the partial pressure of gases? Leng pay ad SIjLI! bas How to calculate the partial pressure of 02? @ The atmospheric pr. Is 760mmHg, & contains about 21% of 02, 79% nitrogen & 1% for the (water vapor, noble gases, and CO2). While for the CO2, is 0.25mmHg. 1.Ss Ss Se 82 8 8 Atmospheric PO2 The pressure of 02 at atmosphere (mouth level) is around 1/5 of atmospheric pr. 760X21%=160mmHg=PO2 (pr. Of oxygen in atmosphere & not in the lung). PAO2 (Alveolar) At alveolar level, the 02 pressure (PAO2) is around 100mmhg, due to the presence of 2 pressures (H2O pressure & CO2 pressure). PaO2 (arterial) As oxygen crosses the alveolar wall in to the blood, the 02 pressure (at pulmonary arterial level) becomes less than 100mmhg due to (A-a 02 gradient = PAO2 - PaO2). The difference is about (4-25mmhg). So, The PaO2 at arterial side is around (75- 95mmhg). The gradient is due to aging or diseases. PaQ2 (the (a) means arterial). While PAO2 (the (A) means alveolar) On venous side At tissue level, the RBCs give their oxygen, and the PaO2 will be 40mmHg in the venous side, while the CO2 will build up from 40 to 46mmHg (uptake of O2 & production of CO2). At pulmonary circulation, and according to a pressure gradient, the oxygen will build up again, while CO2 will go out (46 to 40mmhg). Look the picture below.C) Lung Alveolar PO.= 40 mmHg —> PO_= 95 mmHg PCO2= 46 mmHg ---> PCO,= 40 mmHg PO,= 40mm Hg <———- PO, = 95 mm Hg =~| tissue I ° Pe) sm_ PCO = 46 mm Hg <—-_ PCO)= 40 mm Hg Oxygen Transport: In the blood. Oxygen transported in to 2 forms: dissolved and carried form. 1- Carried form of oxygen, that's measured by pulse oximetry as a ercentage (_) of oxygen carried by hemoglobin. 2 of oxygen in plasma (PaO2), represents the pressure of 2 in blood. How to understand the 2 forms. + Let's consider the Hb is 15gram/100mlI (this mean that each 100ml of blood contains 15gram of hemoglobin). + Each gram of Hb can carry 1.34ml of oxygen. + So [15gramHb] ] 1.34 ml O2 = 20ml 02/15gram Hb for 100ml blood. -3-+ This 20ml oxygen carried in blood in 2 forms; (19.7ml) carried form bonded to Hb & represents the saturation of hemoglobin (measured by pulse oximeter), while the remaining (0.3ml) represents the dissolved oxygen in plasma & measured by blood gas analyzer (ABG), it represents the tension or pressure of oxygen in blood = (Pa02 measured by mmHg). + So, the 5 liters of blood carry 1000ml oxygen. 19.7 x 10 x 5 = 985 mi carried form. 0.3 x 10 x 5 = 15 ml dissolved form + At rest our body (70kg) needs 250m! 02 for metabolism, while the remaining 02 acts as a reservoir on need like in exercise or fever. Hb 15gram 100ml of blood Each gram carries 1.34ml 02 The 100ml blood carries 20m! 02 Carried 02 (SPO2%) Dissolved 02 (PaO2) 19.7ml of 02 carried on Hb 0.3mI of 02 is dissolved in plasma Called 02 saturation (%) It’s the pressure of 02 (PO2), Measured by pulse Measured by ABG device (bl. gas The relation between the carried & the dissolved oxygen: - If blood volume is Sliters, (in adults 5-6liters). & Hb is 15g/100ml. The 5 liters of blood will carry 1000m! of oxygen. 2 body consumption for 70kg =250mi/minute. The RBCs mostly not give their oxygen directly to the tissue, but the oxygen releases from RBCs & dissolved in plasma to build up a pressure (Pa02). According to pressure gradient 2 will cross the tissue cell membrane. 4. Oxygen dissociation curve: -The relation between carried 02 & dissolve O2 can be made as a curve, known as “the oxygen dissociation curve”. Oxyhemoglobin (% Saturation) 30 P50 =is the po2 when the 70 Hb is 50% saturated = 26.8mmHg When the SPO2% 90 the PaQ2 is 6Ommhg. 8838 8 8 3 0 10 20 30 40 80 7080 90 100 Po. (mmHg) => Pa02 Oxygen dissociation curve: - NOTES Hence the curve has a sigmoidal or S-shape. At PaO2 above 60 mmHg, the curve is relatively flat, which means that the oxygen content of the blood (SPO2%) does not change significantly even with more increases in PaO2. (The SPO2% reached 100% while the PaQ2 still increasing). As SPO2% decreases blow 90%, the PaO2 decreases below 60mmhg rapidly (direct relation in this steep area of the curve). 5 P50: means the PaO2 at which the hemoglobin is 50% saturated, & typically = 26.8 mmHg for a healthy person. The P50 is a conventional measure of hemoglobin affinity for oxygen. It is an indicator for the curveshifting Rt. Or Lt. (increase P50 means Rt shift & vice versa). Factors that shift the curve right or left. The Bohr effect which describes hemoglobin's lower affinity — oxygen secondary to increases in the partial pressure of carbon dioxide and/or decreased blood ph. This in turn, enhances the releases of oxygen into tissues to meet the oxygen demand of the tissue. Rope Clb) aI op Bll Af! ob bee ope ne ig Jer F ete Bey JB pl 1. right shift of the curve means, the Hb gives more oxygen to the tissue. like in case of low PH, high H ion, high CO2, high temperature and with fresh blood transfusion (increase in level of 2,3-D iphosphoglycerate ( 2,3 DPG). 2. Left shift of the curve means, less oxygen releases from Hb, as would appear with low temperature, high Ph, low CO2 and low 2,3 DPG. (low 2,3 DPG as with old blood transfusion). 3. Carbon monoxide (CO) has a much higher affinity for hemoglobin than oxygen does. In carbon monoxide poisoning, oxygen cannot be transported and released to body tissues thus resulting in hypoxia. 4, With fetal hemoglobin, the shift facilitates diffusion of oxygen across the placenta. The oxygen dissociation curve for myoglobin exists even further to the left. 6- Factors influence the affinity of this binding & alter the shape ofDPG is a substance temperature low high that makes the DPG low high oxygen easily = released from p(ca) low High hemoglobin. It needs 6-8 hours to be PCO high restored in old blood pH high (alkalosis) low(acidosis) type of Hb fetal Hb adult Hb O2 cascade & CO2 in blood: - At cellular level (cellular respiration), the O2 is important for energy production “ATP” (adenosine triphosphate), while CO2 is a waste product of energy production and should be removed from circulation. C4 Hy,0, + 602 ——> 6CO, + 6H,O + 38 ATP CO2 in blood with cellular respiration (glucose +2 =mme ATP +H20 + C02). At tissue level, the pco2 46mmHg while in the feeding capillary the pco2 40mmHg, & according to the pressure difference the co2 will be washed from the cells & circulate in venous blood back to the heart. (Rt. side). With high ventilation (tachypnea) the PaCO2 decreases. With low ventilation (bradypnea) the PaCO2 increases. 7 In the circulation (arterial or venous) the CO2 will be transfer in 3 formsa) 60%-70% as HCOS b) 23%-30% as CO2 + Hb. c) 7% dissolved in plasma to give the CO2 its partial pressure. Dissolved C02 Protein-bound Chemically- Hco; Modified cr 60- 70% as bicarbonate: - a) The CO2 moves according to pressure gradient from inside to outside the cells in to the blood. b) CO2 mostly pass in to RBCs. And binds to H20 to form carbonic acid (H2C03), which in turn change to H* + (bicarbonate) HCO3- CO2 + H20 mms = H7C Ome Ht + HCO; c) The liberated hydrogen ion combines the hemoglobin, so the Hb will be change to Hb- H’. d) HCO3- goes out of the RBC & instead the Na ion goes in. 8e) As the body full from 70% bicarbonate, it switched off & changed to other way of CO2 carrier. That's combination of CO2 with Hb. 23-30% as CO2 + Hb. (Carboxyl Hb): - After filling of Hb seats, the remaining CO2 will be dissolved in plasma. 7-10% dissolved in plasma & this will represents the (PCO2). 46mmHg. At lung level, the above 3 conditions will be reversed as follow: - Bicarbonate renters the RBCs. a) The Na ion will go out. & HCO3-enter the RBCs to form CO2 HCO3 + Hmmm = H2CO Same H20 + CO2 b) CO2 leaves out of the RBCs to be dissolved in plasma (PCO2) to. leave through alveoli. C02 leaves hemoglobin & dissolved in plasma to make more PCO2 & to leave through alveoli. Dissolved (PCO2 46mmHg) that’s the 7% pass out through alveoli, and keep out going by pressure difference.