Oxygen toxicity

Background

• Resulting from the harmful effects of breathing oxygen at elevated partial pressures

Clinical Features

Pulmonary

• Tracheobronchial irritation → pleuritic chest pain, dyspnea and coughing
• Atelectasis
• Diffuse alveolar damage → Pulmonary edema/ARDS

Central nervous system

• Tunnel vision
• Tinnitus
• Nausea
• Facial twitching
• Irritability (personality changes, anxiety, confusion, etc.)
• Seizure

Ocular

• Generally only seen in infants
  • Retinopathy of prematurity (retrolentar fibroplasia)
• In adults exposed to repeated toxic levels of oxygen, can get hyperoxic myopia, which resolves spontaneously

Differential Diagnosis

Diving Emergencies

• Barotrauma of descent
  • Otic barotrauma
  • Pulmonary barotrauma
  • Sinus barotrauma
  • Mask squeeze
  • Barodentalgia (trapped dental air causing squeeze)
• Barotrauma of ascent
  • Pulmonary barotrauma (pulmonary overpressurization syndrome)
  • Decompression sickness (DCS)
  • Arterial gas embolism
  • Alternobaric vertigo
  • Facial baroparesis (Bells Palsy)
• At depth injuries
  • Oxygen toxicity
  • Nitrogen narcosis
  • Hypothermia
  • Contaminated gas mixture (e.g. CO toxicity)
  • Caustic cocktail from rebreathing circuit

Diagnosis

• Clinical diagnosis

Management

• Removal from high partial pressure of oxygen, if possible

Disposition

• Admit

See Also

• Oxygen therapy