Dr.

Niranjan Murthy HL
Asst. Prof. of Physiology
SSMC, Tumkur
• Mt. Everest

• Deep sea divers

• Space travel

• Neonatal breathing
 HIGH ALTITUDE
• Atmospheric pressure exponentially
reduce as we ascend up
• Mt. Everest- 29k ft- 253 mm Hg- PO2 43
mm Hg
• 63,000 ft- 47 mm Hg- PO2 ‘0’ mm Hg
• Acclimatization is important
• >10 million live above 10k ft
 Acute mountain sickness
• c/f: headache, nausea, palpitations, fatigue,
dizziness, loss of appetite, insomnia.
• May be due to combination of hypoxemia and
alkalosis
• Periodic breathing
• Increased cerebral blood flow
• Monge’s disease- chronic mountain sickness-
fatigue, polycythemia, reduced exercise
tolerance, severe hypoxemia
 Acclimatization
Hyperventilation:
• Hypoxic stimulation of peripheral
chemoreceptors
• hypoxia  hyperventilation  hypocapnia
 inhibition of central chemoreceptors 
hypoventilation
• Increased renal excretion of HCO3-

Polycythemia:
• Increased O2 carrying capacity
Shift to right of O2 dissociation curve:
• Increased 2,3-DPG
• O2 release increase by 10%
Increase in peripheral capillaries:
Increase in oxidative enzymes:
Increased max breathing capacity:
*Pulmonary hypertension & RVH
*Pulmonary edema
 Deep sea diving
• Pressure increases by 1 atm for every 33ft
descent.

• Gases compress as we descend and

expand as we ascend
 Decompression Sickness
• Dysbarism, Bends, Caisson’s Disease
• N2 is poorly soluble
• At high pressures it is forced into tissues
• Fat has high N2 solubility
• N2 in diver at 300 ft is 10 L
• N2 removal is slower in ascent
• Rapid decompression can cause bubbling
out of N2
• Bends- pain in joints
• Chokes- dyspnoea
• Deafness, impaired vision, vestibular
disturbances, paralysis
• Avascular necrosis of femoral head
• Rx- recompression and decompression in
a chamber
• Use of helium-oxygen mixture
• Pure oxygen is contraindicated
 Inert gas narcosis
• N2 is regarded as physiologically inert
• At high PN2 it affects CNS
• At 150ft- feeling of euphoria
• Lower down- loss of co-ordination and
coma
 SCUBA
• SELF CONTAINED UNDERWATER
BREATHING APPARATUS

• Diver should ascend with exhaling

 Shallow water blackout
• Divers tend to hyperventilate before a dip
• PCO2 falls
• PaO2 should fall for respiratory drive
• With the ascent, PAO2 and subsequently
PaO2 fall further and cause loss of
consciousness
 Drowning
• Dry drowning

• Wet drowning- (i) fresh water

(ii) salt water

• Blood gas changes- hypoxemia,

hypercapnia, acidosis
• Artificial gills
• Liquid breathing

CORIXA
 Oxygen toxicity
• Guinea pigs placed in 100% oxygen at
atmospheric pressure will develop
pulmonary edema in 48hrs
• Retrolental fibroplasia in premature
infants- can be avoided by keeping O2
concentration <40%
• Absorption atelectasis- N2 and other inert
gases act as splint against collapse as
they have low solubility