The Left Shifted Oxyhemoglobin Curve in Sepsis

Abstract

Nine patients with severe sepsis were studied to determine causes for any alterations in oxygen dissociation. Seven of the patients had oxyhemoglobin curves shifted to the left of expected and diminished DPG levels. These deficiences were not corrected in one case. The other eight patients survived or expired with normal to elevated P(50T) and DPG levels. In this study, three factors occurring either individually, in concordance, or in sequence were present when P(50T) was decreased. Correction of these deficiencies lead to normalization and, in one case, exceedingly high P(50T) and DPG levels. Where hypophosphatemia, acidosis, and transfusion of DPG deficient blood were avoided, no such change occurred. Hypophosphatemia is a common occurrence in the seriously ill patient whether or not hyperalimentation is used and may occur in spite of phosphate supplementation. Blood transfusions with CPD as the preservative are effective in reducing the severity of this disorder by the addition of an inorganic phosphate load. Septic shock itself had no untoward effect on oxygen dissociation. This held true even in the terminal stages of the disease process.

Configuration of the hemoglobin oxygen dissociation curve demystified: a basic mathematical proof for medical and biological sciences undergraduates

“…THE OXYGEN DISSOCIATION CURVE (ODC) of hemoglobin (Hb) as it is taught in physiology lectures has profound clinical importance, being applicable in numerous situations of health and disease, such as in the neonatal period (16), aging (10), hemorrhage (13), hemoglobinopathies (9), septic shock (22), diabetes mellitus (5), oxygenation of tumor tissues (21), sickle cell disease (6), carbon monoxide intoxication (4), anesthesia (12), open heart surgery (7), and respiratory failure (20), just to highlight a few. A close observation of its sigmoidal shape ( Fig.…”

Mathematical Modeling/Problem Solving in Global Oxygen Transport

“…This initial effort at validation, the reasonable answers from a physiologic point of view to the broad scope of the clinical parameters presented, and additionally the fact that the effect on oxygen transport parameters by changes in P 50 as predicted by this model are similar to those observed in human patients [12,13], all demonstrate the value of this approach which should be useful in clinical and theoretical research in global oxygen transport. [14].…”

Understanding Red Blood Cell Rheology in Sepsis and its Role in Clinical Practice. From Biomolecular Aspects to Possible Therapeutic Interventions

“…2,3-DPG synthesis is increased in the presence of hypoxaemia and acidemia resulting in right shifting of the oxyhemoglobin disociation curve (ODC), decreased oxygen affinity to hemoglobin and increased release of oxygen to the tissues (Bohr effect). Studies results may seem paradoxical as a first face because some of them suggest that the RBC ODC is shifted to the left [73,86,87], while others suggest both effects [85]. Recently, Lin et al, reported on a CLP murine sepsis model, reduced Bohr effect (increased P50 and increased hemoglobin affinity for O 2 ) at 3 distinct values for pH (7.2, 7.4, 7.6) and reduced RBC deformability.…”