‘Happy Hypoxia’ is one such condition that has been seen in a lot of patients with COVID-19.In happy hypoxia, a person’s oxygen levels are so low that they should be fainting or experiencing organ damage, but instead, they are seemingly well, until eventually they collapse. It is also called as ‘silent hypoxia’. COVID-19 is primarily a respiratory illness, and a severe case can reduce the amount of oxygen that the lungs can absorb. Blood oxygen levels have been found to be very low in some COVID-19 patients. Hypoxia is a warning signal for imminent failure of vital body organs like the kidneys, brain, heart and is usually accompanied by prominent breathlessness. ’Happy Hypoxia’ does not prompt any such obvious external signs. As a result, in the initial stages of sickness, the COVID-19 patient, on the outside, appears to be alright and “happy”.
Blood
oxygen levels below 90 percent are considered to be too low and oxygen
therapy is needed for such patients. A person with low oxygen levels would have
symptoms like shortness of breath and chest pain. However, in happy hypoxia, the
person shows no such symptoms.
A
pulse oximeter is used to detect blood oxygen levels in a COVID-19 patient.3
Also, in conditions like pneumonia, the reduction in blood oxygen
saturation levels are accompanied by fluid collection and raised carbon dioxide
levels in the lungs. The latter is what makes them unable to breathe properly
instead of the low blood oxygen levels.
Hypoxemia,
if left unchecked, leads to a condition called hypoxia (low tissue levels of
oxygen), which can cause organ damage.1
WHEN
TO WORRY
Silent hypoxemia may disguise
severity of clinical status in COVID-19 patients, and ultimately delay their
seeking medical care. Patients admitted with COVID-19 may die without ever
expressing the need for supplemental oxygen. Such hypoxemia can lead to the
erroneous conclusion that patients are not in serious or critical condition,
with the concomitant danger that they may quickly jump clinical evolution
stages and develop ARDS, resulting in cardio respiratory arrest and death.5
It is urgent that the medical
community be alert to silent hypoxemia in COVID-19, to assist physicians in
their attempts to reduce the risk of sudden medical complications and death.
AETIOLOGY
The
following possible causes of happy hypoxia are observed in several studies.
1. Difficulty
in breathing is a symptom, not a sign:
Dyspnea (difficulty in breathing)
is a symptom, only experienced by the patient, and not a sign that can be
observed by others around the patient. A healthcare practitioner or a care
giver cannot catch it until the patient shows signs like rapid breathing, fast
heart beats or any other signs associated with the condition.
2.
Carbon dioxide (CO2) tells the brain about hypoxia:
Our
brain senses carbon dioxide levels not oxygen levels in our blood. Minute changes
in ventilation only occur after PaO2 (partial pressure of oxygen
during exhalation) starts to drop below 60 mmHg. PaO2 is the measure
of the pressure of oxygen in the blood in arteries. It tells you how well the
oxygen is passing through the lungs and into the blood. Normal PaO2
levels are between 75-100 mmHg.3
In
a study it was found that even a decrease of end-tidal PaO2 below 60
mmHg only increased dyspnea in half of the subjects even though all subjects
should have experienced it. On the other hand, even a small increase in the
pressure of carbon dioxide in arterial blood (PaCO2) would show
large changes in ventilation. Even a reduction of blood carbon dioxide
saturation level by 10mm Hg can cause respiratory issues that a person cannot
tolerate for even a minute. But, severe hypoxia only leads to an increase in
ventilation when the PaCO2 goes above 39 mmHg.
3.
ACE2 receptors are present on brain cells that respond to hypoxia: Hypoxemia
induces breathing difficulty through special chemical receptors called carotid
bodies present in the brain. ACE2 receptors, the cell surface receptors that
the COVID-19 causing virus uses to enter healthy cells, are present on carotid
bodies too. So, it is a possibility that these receptors may play a role in
dyspnea, however, more studies are needed to understand this.
4.
Pulse oximeters are not as effective in critically-ill patients: Pulse
oximeters are not as efficient in noting low oxygen saturation levels.
5.
Fever may affect the way our body responds to hypoxia: Fever,
a symptom of COVID-19, may have something to do with happy hypoxia. The carotid
bodies in the brain only respond to PaO2 and not SaO2.
However, the two could vary at different temperatures.2
SOME
MORE FINDINGS
In the latest study, the
researchers at Loyola University took a poll from about 58 hospitals and
healthcare practitioners to see if they have seen any patients with happy
hypoxia. They found that 16 patients had PaO2 less than 60 mmHg but
were not experiencing any discomfort. Seven of these patients had their PaCO2
levels above 39 mmHg (in the range between 41-49), which is the sign of
silent hypoxia. However, the rest had PaCO2 levels below 39 mmHg.
Since this level can blunt the effects of hypoxia on the brain, these patients
were not considered to have happy hypoxia.
A
lot of COVID-19 patients are either diabetic or old — two conditions that
reduce the response of the respiratory system to hypoxia. It has been indicated
that diabetics and people older than 65 years have a 50 percent reduced
response to hypoxia. So the study suggested that such patients with COVID-19
may be more prone to silent hypoxia.
Furthermore,
most people have around 300-600 percent difference in their respiratory
drive (the response of their respiratory muscles to the respiratory centres in
their brain). So, while one patient may quickly develop shortness of breath
with higher blood carbon dioxide levels, another one may not.2
SOME OTHER RESONS
Over the last few weeks, many
healthcare workers have observed a rather confusing pattern among some of the
patients. They say that these patients start to show signs of recovery behave
normally and then collapse rapidly without leaving scope for intervention. Some
patients also show an unusual response to very low oxygen levels as they do not
complain of breathlessness or discomfort. This - 'happy hypoxia' - is an
uncharted territory for doctors too.2
Sudden collapse may have been occurring due to many other
reasons for a person. 'Happy hypoxia' is possibly just one subset but this
can't be said conclusively. Other possible reasons are cytokine storms where
the body observes a surge of toxins to fight the coronavirus - can also be seen
as an immune system going overboard. The next is blood vessels getting clotted
and blocked. Then there could be a septic shock and hypoxia."
SYMPTOMS AND SIGNS OF HYPOXEMIA
Symptoms
of hypoxemia may be acute or chronic which mainly include:
- Shortness of breath
- Rapid breathing
- Fast heart rate
- Cough
- Sweating
- Wheezing
- Sensation of choking
- Fluid retention at high altitudes
- Changes in the color of skin from
blue to cherry red
Severe symptoms seen with cerebral
hypoxia may include:
- Confusion
- Inability to communicate
- Coma
WHEN
SEEK PROFESSIONAL HELP
The
patients’ condition may enter into the emergency with blood oxygen levels as
low as 50%, so low they should have been incoherent, even unconscious. Normal
blood oxygen saturation is between 95% and 100%, and anything below 90% is
considered abnormal.
In
addition scans of these patients' lungs showed signs of pneumonia so severe
they should be in terrible pain as they gasp for their next breath. In case of
asthma patients their X-ray's looked
awful, their oxygen was terrible, and yet they're completely awake & alert.
It can be noticed either shortness of breath or fatigue or something else. It's
terrible because by the time a person realizes they are having trouble taking a
deep breath and reaches out for help, they are already dangerously sick. Some
may ultimately require a ventilator as levels of carbon dioxide rise, fluid
builds up in the air sacs and the lungs become stiff, leading to acute
respiratory failure.
HOW TO PREVENT AND MANAGE HYPOXEMIA
- Stop smoking- Smoking can trigger the asthma symptoms leading to hypoxemia.
- Deep breathing and coughing
techniques- These techniques help patients
effectively clear their airway while maintaining their oxygen levels.
- Use of Bronchodilators- Medications such as bronchodilators effectively relax
smooth muscles and open airways in certain disease processes such as COPD.
- Oral suctioning- Patients with muscle disorders or those who have suffered a
cerebral vascular accident (CVA) may have ineffective cough reflexes,
which could lead to hypoxia. Oral suctioning given to these patients may
help to prevent this condition.
- Hypoxic training- Hypoxic training should be given to maintain good health.
- Take medicines and
use the rescue inhaler when needed to help prevent
flares.
- Stress can trigger many respiratory disorders leading to
hypoxemia and should be avoided.
HYPOXIA
AND HOMOEOPATHY
In Homoeopathy there are many
medicines mentioned with Hypoxia situation in human. Some important medicines
are Amon Carb., Aurum Met., Cactus
Grand., Carbo Veg., Camphora, Ignatia Amara, Lachesis, Staphisagaria etc.
In my practical experience I found timely medication is like a wonder to
control the emergency situations. My one case of hypoxia due to Covid-19 was
well responded within three hrs. without any oxygen support. The PaO2
was fallen to 85. Frequent diluted doses of CAMPHORA 1M shows the miraculous
effect and the oxygen label raised up to 95 just in 45 minutes. I experienced
the best of CAMPHORA effect on many Covid-19 positive cases.4
CONCLUSION
If any COVID-19 patients are experiencing
hypoxemia, we must try homoeopathy with thorough confirmation of patients’
symptoms physical & mental as well & put him/her on homoeopathic medicine.
My experience says that if we deal the case of COVID-19 sincerely, we may gate
the good result. In many cases we saw that the patients are dying on ventilators
and they are collapsing after behaving normally, we can consider to use
homoeopathy & I am sure that we can save many more lives. In case of
Hypoxia It can be said that my few patients are having low level of PaO2
(fallen to 82, 85) but with homoeopathy, it shows recovery & saw the
patient become normal in reasonable time. I experienced that one case was in a
condition to put on Oxygen but he prefer to taka homeopathy and waited for few
minutes/hour and the result was good.
2. 2.Dutt
A. Delhi to get 2,000 Oxygen Concentrators, May Change Norms to Buy More PPEs.
Available from: https://www.hindustantimes.com/delhi-news/delhi-to-get-2-000-oxygen-concentrators-may-change-norms-to-buy-more-ppes/story-wTfLjdSCBF0FNFQOvEKZPI.html. Last accessed on 2020
Jun07].
3. 3.Pandey A. Covid-19: Naval Dockyard Manufactures Innovative Portable Multi-Feed Oxygen Manifold. Available from: https://www.indiatoday.in/india/story/covid-19-naval-dockyard- manufactures-innovative-portable-multi-feed-oxygen-manifold-1661553-2020-03-31. [Last accessed on 2020 Jun 07].
. 4.Mac Repertory & reference work by Synergy https://www.synergyhomeopathic.com/meet-the-team/
5. 5.Anoop UR, Verma K. Happy hypoxemia in COVID-19. A neural hypothesis. ACS Chem Neurosci. 2020 Jul 1;11(13):1865–7.
©
