Array ( [0] => {{short description|Abnormally low level of oxygen in the blood}} [1] => {{Infobox medical condition (new) [2] => | name = Hypoxemia [3] => | synonyms = Hypoxaemia [4] => | image = Venous_and_arterial_blood.jpg [5] => | alt = [6] => | caption = Blood with higher oxygen content appears bright red [7] => | pronounce = [8] => | field = [[Pulmonology]] [9] => | symptoms = [10] => | complications = [11] => | onset = [12] => | duration = [13] => | types = [14] => | causes = [15] => | risks = [16] => | diagnosis = [17] => | differential = [18] => | prevention = [19] => | treatment = [20] => | medication = [21] => | prognosis = [22] => | frequency = [23] => | deaths = [24] => }} [25] => [26] => '''Hypoxemia''' is an abnormally low level of [[oxygen]] in the [[blood]].{{cite book| vauthors = Pollak CP, Thorpy MJ, Yager J |title=The encyclopedia of sleep and sleep disorders |url=https://archive.org/details/encyclopediaslee00pcha|url-access=limited|year=2010 |location=New York, NY |isbn=9780816068333|page=[https://archive.org/details/encyclopediaslee00pcha/page/n162 104]|edition=3rd }} More specifically, it is oxygen deficiency in [[artery|arterial]] blood.{{cite book | vauthors = Eckman M |title=Professional guide to pathophysiology |year=2010 |publisher=Wolters Kluwer/Lippincott Williams & Wilkins |location=Philadelphia |isbn=978-1605477664 |page=208 |edition=3rd}} Hypoxemia has many causes, and often causes [[Hypoxia (medical)|hypoxia]] as the blood is not supplying enough oxygen to the tissues of the body. [27] => [28] => ==Definition== [29] => ''Hypoxemia'' refers to the low level of oxygen in blood, and the more general term ''hypoxia'' is an abnormally low oxygen content in any tissue or organ, or the body as a whole. Hypoxemia can cause [[Hypoxia (medical)|hypoxia]] (hypoxemic hypoxia), but hypoxia can also occur via other mechanisms, such as [[anemia]]. [30] => [31] => Hypoxemia is usually defined in terms of reduced [[partial pressure]] of oxygen (mm Hg) in arterial blood, but also in terms of reduced content of oxygen (ml oxygen per dl blood) or percentage saturation of [[hemoglobin]] (the oxygen-binding [[protein]] within [[red blood cell]]s) with oxygen, which is either found singly or in combination.{{cite book| vauthors = Martin L |title=All you really need to know to interpret arterial blood gases|year=1999|publisher=Lippincott Williams & Wilkins |location=Philadelphia|isbn=978-0683306040|page=xxvi|edition=2nd}}{{cite book | vauthors = Morris A, Kanner R, Crapo R, Gardner R | date = 1984 | title = Clinical Pulmonary Function Testing. A manual of uniform laboratory procedures | edition = 2nd }} [32] => [33] => While there is general agreement that an [[arterial blood gas]] measurement which shows that the partial pressure of oxygen is lower than normal constitutes hypoxemia,{{cite book | veditors = Wilson WC, Grande CM, Hoyt DB |title=Critical care |year=2007 |publisher= Informa Healthcare|location=New York|isbn=978-0-8247-2920-2}} there is less agreement concerning whether the oxygen content of blood is relevant in determining hypoxemia. This definition would include oxygen carried by [[hemoglobin]]. The oxygen content of blood is thus sometimes viewed as a measure of tissue delivery rather than hypoxemia. [34] => [35] => Just as extreme hypoxia can be called anoxia, extreme hypoxemia can be called anoxemia. [36] => [37] => ==Signs and symptoms== [38] => {{Main|Hypoxia (medical)#Signs and symptoms}} [39] => [40] => In an acute context, hypoxemia can cause symptoms such as those in [[respiratory distress]]. These include [[dyspnoea|breathlessness]], an increased rate of breathing, use of the chest and abdominal muscles to breathe, and [[Pursed lip breathing|lip pursing]].{{rp|642}} [41] => [42] => Chronic hypoxemia may be compensated or uncompensated. The compensation may cause symptoms to be overlooked initially, however, further disease or a stress such as [[Basal metabolic rate|any increase in oxygen demand]] may finally unmask the existing hypoxemia. In a compensated state, blood vessels supplying less-ventilated areas of the lung may [[vasoconstriction|selectively contract]], to redirect the blood to areas of the lungs which are better ventilated. However, in a chronic context, and if the lungs are not well ventilated generally, this mechanism can result in [[pulmonary hypertension]], overloading the right ventricle of the heart and causing [[cor pulmonale]] and [[right sided heart failure]]. [[Polycythemia]] can also occur.{{cite book |veditors = Colledge NR, Walker BR, Ralston SH |title=Davidson's principles and practice of medicine |year=2010 |publisher=Churchill Livingstone/Elsevier |location=Edinburgh |isbn=978-0-7020-3085-7|edition=21st}} In children, chronic hypoxemia may manifest as delayed growth, neurological development and motor development and decreased sleep quality with frequent sleep arousals.{{cite journal | vauthors = Adde FV, Alvarez AE, Barbisan BN, Guimarães BR | title = Recommendations for long-term home oxygen therapy in children and adolescents | journal = Jornal de Pediatria | volume = 89 | issue = 1 | pages = 6–17 | date = Jan–Feb 2013 | pmid = 23544805 | doi = 10.1016/j.jped.2013.02.003 | doi-access = free }} [43] => [44] => Other symptoms of hypoxemia may include [[cyanosis]], [[digital clubbing]], and symptoms that may relate to the cause of the hypoxemia, including [[cough]] and [[hemoptysis]].{{rp|642}} [45] => [46] => Serious hypoxemia typically occurs when the partial pressure of oxygen in blood is less than {{convert|60|mmHg|kPa|abbr=on}}, the beginning of the steep portion of the [[oxygen–hemoglobin dissociation curve]], where a small decrease in the partial pressure of oxygen results in a large decrease in the oxygen content of the blood.{{cite book | vauthors = Del Sorbo L, Martin EL, Ranieri VM | date = 2010 | chapter = Hypoxemic Respiratory Failure | title = Murray & Nadel's Textbook of Respiratory Medicine | veditors = Mason RJ, Broaddus VC, Martin TR, King TE, Schraufnagel D, Murray JF, Nadel JA | edition = 5th | location = Philadelphia | publisher = Saunders Elsevier | isbn = 978-1-4160-4710-0}}{{cite book | vauthors = Schwartzstein R, Parker MJ | title=Respiratory Physiology: A Clinical Approach | publisher=Lippincott Williams & Wilkins | location=Philadelphia | year=2006 | isbn=978-0-7817-5748-5 | oclc=62302095 }} Severe hypoxia can lead to [[respiratory failure]] [47] => [48] => ==Causes== [49] => Hypoxemia refers to insufficient oxygen in the blood. Thus any cause that influences the rate or volume of air entering the lungs ('''ventilation''') or any cause that influences the transfer of air from the lungs to the blood may cause hypoxemia. As well as these respiratory causes, [[cardiovascular]] causes such as [[shunt (medical)|shunts]] may also result in hypoxemia. [50] => [51] => Hypoxemia is caused by five categories of etiologies: [[hypoventilation]], [[Ventilation perfusion mismatch|ventilation/perfusion mismatch]], [[right-to-left shunt]], diffusion impairment, and low PO2. Low PO2 and hypoventilation are associated with a normal [[alveolar–arterial gradient]] (A-a gradient) whereas the other categories are associated with an increased A-a gradient.{{cite book| veditors = Harrison TR, Fauci AS |title=Harrison's principles of internal medicine |year=2008 |publisher=McGraw-Hill Medical |location=New York|isbn=978-0-07-147692-8|edition=17th}} {{rp|229}} [52] => [53] => ===Ventilation=== [54] => If the [[Pulmonary alveolus|alveolar]] ventilation is low, there will not be enough oxygen delivered to the alveoli for the body's use. This can cause hypoxemia even if the lungs are normal, as the cause is in the brainstem's control of ventilation or in the body's inability to breathe effectively. [55] => [56] => ====Respiratory drive==== [57] => [[Control of respiration|Respiration is controlled]] by centers in the [[Medulla oblongata|medulla]], which influence the rate of breathing and the depth of each breath. This is influenced by the blood level of carbon dioxide, as determined by central and peripheral chemoreceptors located in the central nervous system and carotid and aortic bodies, respectively. Hypoxia occurs when the breathing center doesn't function correctly or when the signal is not appropriate: [58] => * [[Stroke]]s, [[epilepsy]] and cervical neck fractures can all damage the medullary [[respiratory centres]] that generates rhythmic impulses and transmit them along the [[phrenic nerve]] to the [[Thoracic diaphragm|diaphragm]], the muscle that is responsible for breathing. [59] => * A decreased respiratory drive can also be the result of [[metabolic alkalosis]], a state of decreased [[carbon dioxide]] in the blood [60] => * [[Central sleep apnea]]. During sleep, the breathing centers of the brain can pause their activity, leading to prolonged periods of apnea with potentially serious consequences. [61] => * [[Hyperventilation]] followed by prolonged breath-holding. This hyperventilation, attempted by some swimmers, reduces the amount of carbon dioxide in the lungs. This reduces the urge to breathe. However, it also means that falling blood oxygen levels are not sensed, and can result in hypoxemia.{{cite journal | vauthors = Craig AB | title = Summary of 58 cases of loss of consciousness during underwater swimming and diving | journal = Medicine and Science in Sports | volume = 8 | issue = 3 | pages = 171–175 | date = Fall 1976 | pmid = 979564 | doi = 10.1249/00005768-197600830-00007 | doi-access = free }} [62] => [63] => ====Physical states==== [64] => A variety of conditions that physically limit airflow can lead to hypoxemia. [65] => * [[Asphyxia|Suffocation]], including temporary interruption or cessation of breathing as in [[obstructive sleep apnea]], or bedclothes may interfere with breathing in infants, a putative cause of [[Sudden infant death syndrome|SIDS]]. [66] => * Structural deformities of the chest, such as [[scoliosis]] and [[kyphosis]], which can restrict breathing and lead to hypoxia. [67] => * [[Myopathy|Muscle weakness]], which may limit the ability of the [[Thoracic diaphragm|diaphragm]], the primary muscle for drawing new air into lungs, to function. This may be a result of a [[Birth defect|congenital disease]], such as [[motor neuron disease]], or an acquired condition, such as fatigue in severe cases of [[COPD]]. [68] => [69] => ====Environmental oxygen==== [70] => [[File:Oxyhaemoglobin dissociation curve.png|thumb|Oxygen-Hemoglobin Dissassociation Curve.]] [71] => [72] => In conditions where the proportion of oxygen in the air is low, or when the [[partial pressure]] of oxygen has decreased, less oxygen is present in the alveoli of the lungs. The alveolar oxygen is transferred to [[hemoglobin]], a carrier protein inside [[red blood cell]]s, with an efficiency that decreases with the partial pressure of oxygen in the air. [73] => [74] => *[[Altitude]]. The external partial pressure of oxygen decreases with altitude, for example in areas of high altitude or when [[Aviation|flying]]. This decrease results in decreased carriage of oxygen by hemoglobin.{{cite web | vauthors = Baillie K, Simpson A |title=Altitude oxygen calculator |url=http://www.altitude.org/oxygen_levels.php |publisher=Apex (Altitude Physiology Expeditions) |access-date=2006-08-10 |archive-url=https://web.archive.org/web/20170611073650/http://www.altitude.org/oxygen_levels.php |archive-date=2017-06-11 |url-status=dead }} – Online interactive oxygen delivery calculator. This is particularly seen as a cause of [[cerebral hypoxia]] and [[Altitude sickness|mountain sickness]] in climbers of [[Mount Everest]] and other peaks of extreme altitude.{{cite journal | vauthors = West JB, Boyer SJ, Graber DJ, Hackett PH, Maret KH, Milledge JS, Peters RM, Pizzo CJ, Samaja M, Sarnquist FH | display-authors = 6 | title = Maximal exercise at extreme altitudes on Mount Everest | journal = Journal of Applied Physiology | volume = 55 | issue = 3 | pages = 688–698 | date = September 1983 | pmid = 6415008 | doi = 10.1152/jappl.1983.55.3.688 | hdl-access = free | hdl = 2434/176393 }}{{cite journal | vauthors = Grocott MP, Martin DS, Levett DZ, McMorrow R, Windsor J, Montgomery HE | title = Arterial blood gases and oxygen content in climbers on Mount Everest | journal = The New England Journal of Medicine | volume = 360 | issue = 2 | pages = 140–149 | date = January 2009 | pmid = 19129527 | doi = 10.1056/NEJMoa0801581 | url = https://research.brighton.ac.uk/en/publications/ba1483ec-4ad4-47c2-b504-57529d1fed8e | doi-access = free }} For example, at the peak of Mount Everest, the partial pressure of oxygen is just 43 mmHg, whereas at sea level the partial pressure is 150 mmHg.{{cite journal | vauthors = West JB | title = Human limits for hypoxia. The physiological challenge of climbing Mt. Everest | journal = Annals of the New York Academy of Sciences | volume = 899 | issue = 1 | pages = 15–27 | year = 2000 | pmid = 10863526 | doi = 10.1111/j.1749-6632.2000.tb06173.x | s2cid = 21863823 | bibcode = 2000NYASA.899...15W }} For this reason, [[Cabin pressurization|cabin pressure in aircraft]] is maintained at 5,000 to 6,000 feet (1500 to 1800 m).{{cite web|url=http://www.ersnet.org/index.php?option=com_flexicontent&view=items&id=4106:airlines-are-cu|title=Airlines are cutting costs – Are patients with respiratory diseases paying the price? |last=Administrator|website=www.ersnet.org|access-date=2016-06-17}} [75] => *[[Underwater diving|Diving]]. Hypoxia in diving can result from sudden surfacing. The partial pressures of gases increases when diving by one ATM every ten metres. This means that a partial pressure of oxygen sufficient to maintain good carriage by hemoglobin is possible at depth, even if it is insufficient at the surface. A diver that remains underwater will slowly consume their oxygen, and when surfacing, the partial pressure of oxygen may be insufficient ([[shallow water blackout]]). This may manifest at depth as [[Freediving blackout#Ascent blackout|deep water blackout]]. [76] => *[[Suffocation]]. Decreased concentration of oxygen in inspired air caused by reduced replacement of oxygen in the breathing mix. [77] => *[[Anaesthetic]]s. Low partial pressure of oxygen in the lungs when switching from inhaled [[anesthesia]] to atmospheric air, due to the [[Fink effect]], or diffusion hypoxia. [78] => * Air depleted of oxygen has also proven fatal. In the past, [[Anaesthetic machine|anesthesia machines]] have malfunctioned, delivering low-oxygen gas mixtures to patients. Additionally, oxygen in a confined space can be consumed if [[carbon dioxide scrubber]]s are used without sufficient attention to supplementing the oxygen which has been consumed. [79] => * Hypoxic or anoxic breathing gas mixtures, and exposure to a vacuum or other extreme low pressure environment will remove oxygen from the blood in the alveoli.{{cite web |url=http://www.geoffreylandis.com/vacuum.html |title=Human Exposure to Vacuum |date=7 August 2007 |first=Geoffrey A. |last=Landis |author-link=Geoffrey A. Landis |access-date=2012-04-25 |publisher=www.geoffreylandis.com |url-status=dead |archive-url=https://web.archive.org/web/20090721182306/http://www.geoffreylandis.com/vacuum.html |archive-date=2009-07-21 }} [80] => [81] => ===Perfusion=== [82] => [83] => ====Ventilation-perfusion mismatch==== [84] => This refers to a disruption in the ventilation/perfusion equilibrium. Oxygen entering the lungs typically diffuses across the alveolar-capillary membrane into blood. However this equilibration does not occur when the alveolus is insufficiently ventilated, and as a consequence the blood exiting that alveolus is relatively hypoxemic. When such blood is added to blood from well ventilated alveoli, the mix has a lower oxygen partial pressure than the alveolar air, and so the A-a difference develops. Examples of states that can cause a ventilation-perfusion mismatch include: [85] => * Exercise. Whilst modest activity and exercise improves ventilation-perfusion matching,{{cite journal | vauthors = Whipp BJ, Wasserman K | title = Alveolar-arterial gas tension differences during graded exercise | journal = Journal of Applied Physiology | volume = 27 | issue = 3 | pages = 361–365 | date = September 1969 | pmid = 5804133 | doi = 10.1152/jappl.1969.27.3.361 }} hypoxemia may develop during intense exercise as a result of preexisting lung diseases.{{Cite book| vauthors = Hopkins SR |chapter=Exercise Induced Arterial Hypoxemia: The role of Ventilation-Perfusion Inequality and Pulmonary Diffusion Limitation |volume=588|pages=17–30|pmid=17089876|doi=10.1007/978-0-387-34817-9_3|series=Advances in Experimental Medicine and Biology|date=2007 |publisher=Springer |location=Boston, MA |isbn=978-0-387-34816-2|title=Hypoxia and Exercise}} During exercise, almost half of the hypoxemia is due to diffusion limitations (again, on average).{{cite journal | vauthors = Agustí AG, Roca J, Gea J, Wagner PD, Xaubet A, Rodriguez-Roisin R | title = Mechanisms of gas-exchange impairment in idiopathic pulmonary fibrosis | journal = The American Review of Respiratory Disease | volume = 143 | issue = 2 | pages = 219–225 | date = February 1991 | pmid = 1990931 | doi = 10.1164/ajrccm/143.2.219 }} [86] => * [[Aging]]. An increasingly poor match between ventilation and perfusion is seen with age, as well as a decreased ability to compensate for hypoxic states. {{rp|646}} [87] => * Diseases that affect the [[pulmonary interstitium]] can also result in hypoxia, by affecting the ability of oxygen to diffuse into arteries. An example of these diseases is [[pulmonary fibrosis]], where even at rest a fifth of the hypoxemia is due to diffusion limitations (on average). [88] => * Diseases that result in acute or chronic [[respiratory distress]] can result in hypoxia. These diseases can be acute in onset (such as obstruction by inhaling something or a [[pulmonary embolus]]) or chronic (such as [[chronic obstructive pulmonary disease]]). [89] => * [[Cirrhosis]] can be complicated by refractory hypoxemia due to high rates of blood flow through the lung, resulting in ventilation-perfusion mismatch.{{cite journal | vauthors = Agusti AG, Roca J, Rodriguez-Roisin R | title = Mechanisms of gas exchange impairment in patients with liver cirrhosis | journal = Clinics in Chest Medicine | volume = 17 | issue = 1 | pages = 49–66 | date = March 1996 | pmid = 8665790 | doi = 10.1016/s0272-5231(05)70298-7 }} [90] => * [[Fat embolism syndrome]], in which fat droplets are deposited in the pulmonary capillary bed.{{cite book | vauthors = Adeyinka A, Pierre L | chapter = Fat Embolism | date = September 2022 | title = StatPearls [Internet]. | location = Treasure Island (FL) | publisher = StatPearls Publishing }} [91] => [92] => ====Shunting==== [93] => [[Shunt (medical)|Shunting]] refers to blood that bypasses the pulmonary circulation, meaning that the blood does not receive oxygen from the alveoli. In general, a shunt may be within the heart or lungs, and cannot be corrected by administering oxygen alone. Shunting may occur in normal states: [94] => * Anatomic shunting, occurring via the [[Bronchial artery|bronchial circulation]], which provides blood to the tissues of the lung. Shunting also occurs by the [[smallest cardiac veins]], which empty directly into the left ventricle. [95] => * Physiological shunts, occur due to the effect of gravity. The highest concentration of blood in the pulmonary circulation occurs in the bases of the pulmonary tree compared to the highest pressure of gas in the apexes of the lungs. [[Pulmonary alveolus|Alveoli]] may not be ventilated in shallow breathing. [96] => Shunting may also occur in disease states: [97] => * [[Acute respiratory distress syndrome]] (ARDS). Alveolar collapse, which can increase the amount of physiological shunting, may be managed through a combination of increasing oxygenation as well as positive pressure to recruit collapsed alveoli.{{cite journal | vauthors = Huang YC, Fracica PJ, Simonson SG, Crapo JD, Young SL, Welty-Wolf KE, Moon RE, Piantadosi CA | display-authors = 6 | title = VA/Q abnormalities during gram negative sepsis | journal = Respiration Physiology | volume = 105 | issue = 1–2 | pages = 109–121 | date = August 1996 | pmid = 8897657 | doi = 10.1016/0034-5687(96)00039-4 }}{{cite journal | vauthors = Thompson BT, Chambers RC, Liu KD | title = Acute Respiratory Distress Syndrome | journal = The New England Journal of Medicine | volume = 377 | issue = 6 | pages = 562–572 | date = August 2017 | pmid = 28792873 | doi = 10.1056/NEJMra1608077 | s2cid = 4909513 }} [98] => * Pathological shunts such as [[patent ductus arteriosus]], [[patent foramen ovale]], and [[atrial septal defect]]s or [[ventricular septal defect]]s. These states are when blood from the right side of the heart moves straight to the left side, without first passing through the lungs. This is known as a [[right-to-left shunt]], which is often congenital in origin. [99] => [100] => === Exercise === [101] => Exercise-induced arterial hypoxemia occurs during exercise when a trained individual exhibits an arterial oxygen saturation below 93%. It occurs in fit, healthy individuals of varying ages and genders.{{cite journal | vauthors = Dempsey JA, Wagner PD | title = Exercise-induced arterial hypoxemia | journal = Journal of Applied Physiology | volume = 87 | issue = 6 | pages = 1997–2006 | date = December 1999 | pmid = 10601141 | doi = 10.1152/jappl.1999.87.6.1997 | s2cid = 6788078 }} Adaptations due to training include an increased cardiac output from cardiac hypertrophy, improved venous return, and metabolic vasodilation of muscles, and an increased [[VO2 max|VO2 max]]. There must be a corresponding increase in VCO2 thus a necessity to clear the carbon dioxide to prevent a [[metabolic acidosis]]. Hypoxemia occurs in these individuals due to increased pulmonary blood flow causing: [102] => *'''Reduced capillary transit time''' due to an increased blood flow within the pulmonary capillary. Capillary transit time (tc), at rest is around 0.8s, allowing plenty of time for the diffusion of oxygen into the circulation and the diffusion of CO2 out of the circulation. After training, the capillary volume is still the same however cardiac output is increased, resulting in a decreased capillary transit time, reducing to around 0.16s in trained individuals at maximal work rates. This does not give sufficient time for gas diffusion and results in a hypoxemia. [103] => *'''Intrapulmonary arteriovenous shunts''' are dormant capillaries within the lungs that become recruited when venous pressures become too high. They are normally located within deadspace area where gas diffusion does not occur, thus the blood passing through does not become oxygenated resulting in a hypoxemia. [104] => [105] => ==Physiology== [106] => {{Main|Hypoxia (medical)#Physiological compensation}} [107] => Key to understanding whether the lung is involved in a particular case of hypoxemia is the [[Alveolar–arterial gradient|difference between the alveolar and the arterial oxygen levels]]; this A-a difference is often called the A-a ''gradient'' and is normally small. The arterial oxygen partial pressure is obtained directly from an arterial [[Blood gas|blood gas determination]]. The oxygen contained in the alveolar air can be calculated because it will be directly proportional to its fractional composition in air. Since the airways humidify (and so dilute) the inhaled air, the [[barometric pressure]] of the [[atmosphere]] is reduced by the vapor pressure of water. [108] => [109] => ==History== [110] => The term hypoxemia was originally used to describe low blood oxygen occurring at high altitudes and was defined generally as defective oxygenation of the blood. [111] => Henry Power and Leonard W. Sedgwick (1888) New Sydenham Society's Lexicon of Medicine and the Allied Sciences (Based on Maye's Lexicon). Vol III. London: New Sydenham Society. [112] => [113] => [114] => In modern times there are a lot of tools to detects hypoxemia including [[Smartwatch|smartwatches]]. In 2022 a research has shown smartwatches can detect short-time hypoxemia as well as standard medical devices.{{cite journal | vauthors = Rafl J, Bachman TE, Rafl-Huttova V, Walzel S, Rozanek M | title = Commercial smartwatch with pulse oximeter detects short-time hypoxemia as well as standard medical-grade device: Validation study | journal = Digital Health | volume = 8 | pages = 20552076221132127 | date = 2022 | pmid = 36249475 | pmc = 9554125 | doi = 10.1177/20552076221132127 }}{{Cite web | author = Charles University Environment Center|title=Commercial smartwatch provides reliable blood oxygen saturation values as compared to a medical-grade pulse oximeter |url=https://medicalxpress.com/news/2022-11-commercial-smartwatch-reliable-blood-oxygen.html |access-date=2022-11-17 |website=medicalxpress.com |language=en}} [115] => [116] => == References == [117] => {{Reflist}} [118] => [119] => == Further reading == [120] => {{refbegin}} [121] => * {{cite book | vauthors = West JB |title=Pulmonary Pathophysiology: The Essentials |edition=8th |year=2012 |publisher=Lippincott Williams & Wilkins |isbn=978-1-4511-0713-5}} [122] => * {{cite book | vauthors = Anderson KN | title=Mosby's Medical, Nursing & Allied Health Dictionary |edition=6th |year=2002 |publisher=C.V. Mosby |isbn=978-0-323-01430-4|title-link= Mosby's Medical, Nursing & Allied Health Dictionary }} [123] => * {{cite book | veditors = Hess DR, MacIntyre NR, Mishoe SC, Galvin WF, Adams AB | date = 2012 | chapter = Respiratory Care: Principles and Practice | edition = 2nd | title = Jones and Bartlet Learning | isbn = 978-0-7637-6003-8 | last1 = Hess | first1 = Dean | last2 = MacIntyre | first2 = Neil | last3 = Mishoe | first3 = Shelley | publisher = Jones & Bartlett Learning }} [124] => * {{cite book | vauthors = Samuel J, Frankling C | chapter = Hypoxemia and Hypoxia | veditors = Myers JA, Millikan KW, Saclarides TJ | date = 2008 | title = Common Surgical Diseases | edition = 2nd | pages = 391–394 | publisher = Springer | isbn = 978-0-387-75245-7}} [125] => {{refend}} [126] => [127] => == External links == [128] => {{Medical resources [129] => | DiseasesDB = [130] => | ICD10 = [131] => | ICD9 = [132] => | ICDO = [133] => | OMIM = [134] => | MedlinePlus = [135] => | MeSH = [136] => | GeneReviewsNBK = [137] => | GeneReviewsName = [138] => | ICD10CM = {{ICD10CM|R09.02}} [139] => }} [140] => {{Circulatory and respiratory system symptoms and signs}} [141] => [142] => [[Category:Physiology]] [] => )
good wiki

Hypoxemia

Hypoxemia is an abnormally low level of oxygen in the blood. More specifically, it is oxygen deficiency in arterial blood.

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