Patient with high tissue oxygenation but low lung function

[Texan123]

I hope someone can help me. My cousin who is 67 and has been healthy and active all his life is ill. He was in California this summer when the forest fires started. They triggered something in him and he now has very diminished lunch capacity: 25%. However, his tissue oxygenation is 98%. This seems totally contradictory. He lives in the Houston Texas area and the physicians have done a bunch of heart tests to rule out heart disease. In the meantime only his wife seems to be worried that his color is gray and he must sit totally straight up or cannot breathe. Tough to sleep this way. This has now been going on for some months and they just keep doing heart tests. His wife thinks it might be coccidioidomycosis or lyme's disease since they were in the southwest and camping in the woods. No one will listen to her to test for this. They haven't even recommended he have oxygen at home. Does anyone have any idea what these symptoms might be? He wheezes and gasps and now low quality of life now. I have recommended that she find a doctor that will run these two tests and also have oxygen available at home. I also recommended they not allow the heart biopsy until they get results back on these tests.

[leslie :-D]

i would have him see a pulmonologist immediately.

wishing him the very best.

leslie

[tconlgirl]

hmmm.. any information regarding his lab values? RBC H&H I know it is against forum rules and nursing practice to " practice medicine" ;and I am still a student nurse at this point but I would be concerned about polycythemia... perhaps... just a thought... any other ideas?

[hypocaffeinemia, BSN, RN]

However, his tissue oxygenation is 98%.

...

...his color is gray and he must sit totally straight up or cannot breathe.

...He wheezes and gasps and now low quality of life now.

The last two statements paint a picture of someone with poor perfusion. The SpO2 number isn't everything-- the clinical picture is entirely different and matches his lack of lung function. If this weren't chronic I'd think CO poisoning from the forest fire and the high SpO2.

I second the recommendation to see a pulmonologist asap. There are a ton of excellent pulmonologists in the Houston area.

Also, I do hate to say this, but our air quality here isn't doing him any favors.

[GilaRRT]

As stated pulse oximetry without supporting evidence is a poor indicator of tissue oxygenation. Pulse oximetry is a way of saying, "something is attached to hemoglobin." That something need not be oxygen.

Another concept to consider is the oxyhemoglobin dissociation curve. This is a way to look at the relationship between oxygen and hemoglobin. Anything that shifts the curve to the left will cause hemoglobin to have an increased affinity for oxygen. Oxygen will attach, but it may not be released. It is essentially locked in place. A commonly used analogy is "Left=Lock." You can have high levels of oxyhemoglobin; however, that oxygen may in fact not be going to the cells.

[GrumpyRN63, ADN, RN]

hmmm.. any information regarding his lab values? RBC H&H I know it is against forum rules and nursing practice to " practice medicine" ;and I am still a student nurse at this point but I would be concerned about polycythemia... perhaps... just a thought... any other ideas?

polycythemia was exactly what I was thinking

[miko014]

I'm not giving medical advice, but I will say this:

Other posters have made good points...add these:

First, if he has poor perfusion (ie the wave form on the SPO2 monitor is sucky) then the reading may not be accurate. However, if that is the case, it will usually read a false low.

Second, the sat monitors the amount of O2 that is attached to the hgb that is there. If he doesn't have enough hgb, then his sat may be high, but the cells he has just can't deliver enough O2. In other words, the cells he has are carrying as much O2 as it is possible for them to carry, but they just don't have enough of them helping with the delivery. Make sense?

Also, if his lungs can't handle the amout of O2 his body needs, then home O2 probably wouldn't help. You don't want to blow his lungs out!

[moonchild20002000]

I agree with others...he needs to see a pulmo asap. Has he had pft's or are the numbers coming from a pulse oximeter.?

[morte, LPN, LVN]

yup, pulmo. asap......and if this takes a trip to the ED, so be it....

[jstbreathe]

I would assume since you know his lung capacity, then you have seen a pulmonologist. If your not happy with the Dr or Dr's, then get another. I would suggest a family sit down with the Drs asap. Don't forget a pen and paper to ask question. Good Luck!