Oxygen

Introduction Overview

Generic Name

Oxygen

Brand Name

Medipure by Linde

Dosage Form

Gas (compressed and refrigerated liquid)

Drug Class

Medical gas

Pharmacokinetics

Oxygen is a fundamental element required for aerobic metabolism and is administered as a medical gas via respiratory inhalation. It is not metabolized in the traditional sense but participates in cellular respiration and oxidative phosphorylation.

Absorption:
Oxygen is absorbed primarily through the lungs via diffusion across the alveolar-capillary membrane into the blood. The absorption efficiency depends on the partial pressure gradient of oxygen between alveoli and capillary blood, lung ventilation and perfusion, and the integrity of the alveolar-capillary interface. Oxygen administered in higher concentrations increases the alveolar partial pressure, thereby enhancing absorption and delivery to tissues. The solubility of oxygen in the alveolar lining fluid and plasma, although low, is sufficient for immediate physiological needs before hemoglobin-mediated transport.

Distribution:
Once absorbed into pulmonary capillaries, oxygen binds reversibly to hemoglobin in red blood cells, with a high affinity allowing efficient transport to peripheral tissues. Approximately 98-99% of oxygen is bound to hemoglobin, while 1-2% remains dissolved in plasma. The oxygen-hemoglobin dissociation curve characterizes this relationship and is influenced by pH, temperature, CO2 levels, and 2,3-BPG concentrations. Oxygen distribution to tissues relies on cardiac output, hemoglobin concentration, and tissue metabolic demand.

Metabolism:
Oxygen itself is not metabolized but is critical in oxidative phosphorylation within mitochondria, driving ATP production via the electron transport chain. This biochemical utilization of oxygen supports energy generation in all aerobic cells. Cellular oxygen consumption varies with metabolic activity and tissue type.

Elimination:
The elimination or removal of oxygen occurs through cellular respiration, where it is reduced to water after accepting electrons in the electron transport chain. Excess oxygen is not stored and must be continuously replenished by respiration. In clinical use, excess administered oxygen is exhaled, and the concentration exhaled depends on ventilation settings and patient uptake. Long-term exposure to high concentrations can cause oxidative stress and lung toxicity; thus, monitoring arterial oxygen saturation is essential during therapy.

Dosage Forms

Available Dosage Forms:
Oxygen is available exclusively as a medical gas and is supplied in various compressed gas cylinders and refrigerated liquid containers known as dewars. Specific packaging includes cylinders containing a range of volumes from 142 liters to over 428,000 liters in dewars. The notable dosage forms include:
1. Compressed oxygen gas cylinders with capacities ranging approximately from 142 L to 16,424 L and intermediate sizes (e.g., 425 L, 708 L, 3511 L, 9543 L, etc.).
2. Refrigerated liquid oxygen in dewars ranging from approximately 74,566 L to 428,355 L.

Dosages for Adults and Adolescents:
Oxygen is administered via inhalation, with dosage expressed as fraction of inspired oxygen (FiO2) or flow rate (liters per minute). Typical adult dosages vary depending on clinical indication—from low flow oxygen at 1–6 L/min for mild hypoxia to high flow rates and controlled FiO2 delivery in severe hypoxemia, often ranging up to 100% oxygen. Continuous monitoring of arterial blood gases or oxygen saturation guides titration. Therapy duration varies, emphasizing intermittent use to minimize oxygen toxicity.

Specific Patient Populations:
Special considerations apply to patients with chronic respiratory diseases such as COPD, where oxygen therapy must be carefully titrated to avoid hypercapnia due to hypoventilation. Neonates and pediatric patients require precise dosing guided by specialized equipment due to differing oxygen consumption and sensitivity to hyperoxia. Patients with ischemic or hypoxic tissue conditions benefit from supplemental oxygen tailored to restore optimal oxygen delivery without causing oxidative injury.

Mechanism Of Action

Oxygen acts as a vital molecular element essential for aerobic cellular metabolism and energy production. Upon inhalation, oxygen diffuses through alveolar membranes into the bloodstream, where it binds reversibly to hemoglobin within red blood cells. The oxygen-hemoglobin complex transports oxygen from the lungs to peripheral tissues, enabling cellular respiration.

At the cellular level, oxygen serves as the final electron acceptor in the mitochondrial electron transport chain. It combines with electrons and protons to form water, a reaction that drives the synthesis of adenosine triphosphate (ATP), the energy currency of cells. This mechanism underpins the fundamental biochemical process of oxidative phosphorylation, vital for sustaining life functions.

Clinically, supplemental oxygen increases the partial pressure of oxygen in inspired air, enhancing diffusion across alveolar-capillary membranes and improving systemic oxygen delivery, especially in conditions of hypoxemia caused by respiratory, cardiovascular, or hematologic disorders. Unlike pharmacologic agents that interact with receptors or enzymes, oxygen’s action is physicochemical and mandatory for aerobic metabolism.

Comparatively, while other respiratory gases like medical air provide a fixed fraction of oxygen (~21%), supplemental oxygen allows for titratable oxygen concentrations up to 100%, which is critical for managing profound hypoxia. Research studies have demonstrated that controlled oxygen therapy improves survival in acute hypoxemic states, but excessive oxygen can induce oxidative lung injury, highlighting the importance of careful clinical monitoring.

Pharmacological Actions

Functions as a critical substrate for cellular aerobic respiration and oxidative metabolism.
Increases partial pressure of inspired oxygen to correct hypoxemia.
Enhances oxygen delivery to hypoxic tissues and vital organs.
Supports mitochondrial ATP production by serving as the terminal electron acceptor.
Improves tissue oxygenation in conditions such as respiratory failure, carbon monoxide poisoning, and shock.
Acts as a medical gas to sustain life in critical care and emergency medicine.
Does not undergo metabolism but participates in biochemical reactions fundamental to energy production.
Can influence vascular tone by modulating hypoxic pulmonary vasoconstriction.
Causes vasoconstriction in cerebral circulation at high concentrations, potentially affecting intracranial pressure.
Has oxidizing properties that can potentiate combustion and fire risk.
Can lead to oxygen toxicity with prolonged high concentration exposure, causing lung damage.
Used in hyperbaric oxygen therapy to enhance oxygen dissolution in plasma.
Employed in respiratory therapy to support ventilation in various pulmonary diseases.
Acts synergistically with resuscitative equipment in patients with respiratory arrest.
May modulate inflammatory processes via reactive oxygen species generation.

Therapeutic Or Clinical Uses

Treatment of acute and chronic hypoxemia due to pulmonary diseases.
Emergency resuscitation for oxygen deficiency and respiratory arrest.
Management of carbon monoxide poisoning by competitively displacing CO from hemoglobin.
Supportive therapy in shock states to improve oxygen delivery to tissues.
Adjunctive therapy in anemia to compensate for reduced oxygen carrying capacity.
Used during anesthesia to ensure adequate oxygenation during surgical procedures.
Treatment of cluster headaches as oxygen inhalation can relieve symptoms.
Employed in hyperbaric oxygen therapy for decompression sickness and wound healing.
Support for patients with acute myocardial infarction to prevent ischemic injury.
Oxygen supplementation in neonates with respiratory distress syndrome.
Management of severe infections leading to tissue hypoxia.
Used during transport and critical care scenarios to maintain adequate oxygenation.
Prevention of hypoxia during sedation and diagnostic procedures.
Treatment of pulmonary edema to ease respiratory distress.
Supportive care in chronic obstructive pulmonary disease under monitored conditions.

Side Or Adverse Effects

Oxygen toxicity causing pulmonary inflammation and damage with prolonged high concentration exposure.
Drying and irritation of nasal and respiratory mucosa due to supplemental oxygen delivery.
Possible retinopathy of prematurity in neonates exposed to excessive oxygen concentrations.
Hypercapnia and respiratory depression in COPD patients with inappropriate oxygen dosing.
Barotrauma risk associated with high flow or pressure oxygen delivery systems.
Fire hazard due to increased combustibility in oxygen-enriched atmospheres.
Cryogenic injuries such as frostbite or burns when handling refrigerated liquid oxygen.
Potential absorption atelectasis from high oxygen concentrations causing nitrogen washout.
Oxidative stress-related cellular injury through reactive oxygen species.
Headache and dizziness if oxygen delivery is inconsistent or hypoxic tissues persist.
Rare allergic reaction to oxygen delivery system materials or contaminants.
Risk of oxygen-induced seizures with hyperbaric oxygen therapy at high pressures.
Eye damage or visual disturbances due to excessive oxygen in neonates.
Nasal congestion and epistaxis from prolonged nasal cannula oxygen use.
Fatigue or lethargy secondary to improper oxygen therapy management.

Precautions

Use only under prescription and supervision of trained healthcare professionals.
Monitor arterial blood gases and oxygen saturation to avoid hyperoxia and hypoventilation.
Avoid exposure of oxygen cylinders and equipment to grease, oil, or combustible materials.
Ensure all oxygen delivery equipment is compatible and cleaned for oxygen service.
Maintain proper ventilation in areas where oxygen is used to prevent accumulation and fire risk.
Use caution in patients with chronic respiratory diseases to prevent CO2 retention.
Protect containers from sunlight and heat sources; keep storage temperature below 52°C (125°F).
Employ backflow prevention devices in piping systems to avoid contamination and hazards.
Open cylinder valves slowly to prevent pressure surges and equipment damage.
Close valves completely after use and when cylinders are empty to prevent leaks.
Wear appropriate protective gear, especially when handling refrigerated liquid oxygen.
Avoid force-fitting or changing connections of oxygen containers to prevent leaks or accidents.
Instruct patients and caregivers about the hazards of smoking or open flames near oxygen therapy.
Use oxygen therapy as emergency or supportive care only, except under proper prescription.
Ensure all resuscitative equipment is available when treating apneic patients with oxygen.

Warnings

Oxygen is a strong oxidizer that can cause or intensify fire hazards; strictly avoid smoking or vaping near oxygen sources.
Contains gas under pressure that may explode if heated or mishandled.
Uninterrupted use of high concentration oxygen for prolonged periods without monitoring arterial oxygen content can be harmful.
Do not use on patients who have stopped breathing unless combined with appropriate resuscitative equipment.
Risk of cryogenic burns with refrigerated liquid oxygen; handle with care and wear protective equipment.
Improper or unsupervised use may lead to oxygen toxicity or respiratory complications.
Storage and handling must follow stringent safety protocols to prevent accidents and explosions.
Use only in well-ventilated areas or outdoors to prevent accumulation and fire risk.
Cylinder valves and fittings must be kept free from grease or oil to avoid spontaneous combustion.
Patients with COPD require careful oxygen titration to avoid hypercapnia and respiratory depression.
Avoid sudden opening of valves to prevent pressure surge damage to equipment and personnel.
Oxygen therapy should be discontinued or adjusted if signs of oxygen toxicity appear.
Keep the container upright at all times to prevent malfunction or spillage.
Improper connections or equipment not rated for cylinder pressure may result in hazardous leaks.
Emergency contact (1-800-645-4633) should be known by all users in case of incident.

Contraindication

Not to be used without resuscitative equipment in patients who are apneic or have ceased breathing.
Contraindicated in certain chronic hypercapnic respiratory failure cases without monitoring.
Avoid use if oxygen cylinders or equipment are contaminated with oil, grease, or combustible substances.
Not allowed in environments where open flames or sparks are present due to fire risk.
Contraindicated in uncontrolled pneumothorax unless proper chest drainage is in place.
Patients with untreated severe respiratory acidosis should not receive high flow oxygen without monitoring.
Avoid use in untrained settings or where personnel lack proper knowledge of oxygen handling and safety.
Not suitable for use with incompatible equipment or non-oxygen rated devices.
Do not administer oxygen without physician prescription except in defined emergency scenarios.
Refrain from use in neonates or pediatrics without specialist guidance due to risk of retinopathy.
Avoid excessive oxygen delivery in patients at risk of oxygen-induced hypercapnia.
Not recommended for use in confined spaces without adequate ventilation.
Contraindicated in patients with known hypersensitivity to materials used in oxygen delivery equipment.
Avoid use if safety data sheets have not been reviewed by the operator.
Do not use in a manner inconsistent with established medical protocols and regulations.

Drug Interactions

Oxygen enhances combustion; concomitant use with flammable anesthetics or medications increases fire risk.
Interaction with drugs causing respiratory depression may be amplified when using supplemental oxygen.
May alter pharmacodynamics of vasodilators or vasoconstrictors by impacting tissue oxygenation.
No direct metabolic drug interactions as oxygen is not metabolized by hepatic enzymes.
Concurrent use with certain chemotherapeutic agents may increase oxidative stress.
Interactions with nitric oxide therapy require careful titration to avoid adverse pulmonary effects.
Oxygen therapy can influence blood pH and affect interactions with acid-base sensitive drugs.
Combined use with carbon monoxide or cyanide antidotes enhances oxygen displacement efficacy.
Use with sedatives and opioids requires monitoring due to increased risk of hypoventilation.
No known antagonistic interactions, but overdose risk potentiation with drugs causing hypoxia.
Supplemental oxygen may affect the oxygen-sensitive enzymes and thereby modulate drug efficacy.
Concomitant exposure to high oxygen and reactive drugs may escalate cellular oxidative injury.
Should not be combined with incompatible gases or aerosols without proper medical indication.
May interfere with accuracy of pulse oximetry readings during administration with certain dyes.
Oxygen delivery hardware may affect timing or delivery of inhaled medications if poorly fitted.

Preparations Of The Drug

Compressed oxygen gas cylinders ranging from 142 to 16,424 liters capacity, designed for medical use.
Large volume dewars containing refrigerated liquid oxygen ranging from approximately 74,566 to 428,355 liters.
Oxygen supplied under USP (United States Pharmacopeia) standards ensuring high purity and sterility.
All equipment and containers cleaned and maintained for oxygen service to prevent contamination.
Valve systems equipped with safety features including backflow prevention and pressure regulation.
Packaging includes cylinders labeled with UN1072 for compressed oxygen and UN1073 for refrigerated liquid oxygen.
Distribution by Linde Gas & Equipment Inc., with adherence to strict manufacturing and safety protocols.
Cylinders and dewars designed with pressure ratings suitable for medical gas storage and administration.
Provision of detailed Safety Data Sheets (SDS) accompanying all oxygen preparations.
Cold insulating gloves, face shields, and eye protection recommended for handling refrigerated liquid oxygen.
Regulated packaging to maintain container integrity and prevent exposure to heat or sunlight.
Labeling includes clear warnings about fire hazards and handling instructions for patient and personnel safety.
Readily integrated with resuscitative and respiratory devices for clinical administration.
Prepared in standardized unit doses aligned with clinical needs to facilitate dosing accuracy.
Manufactured in multiple facilities with rigorous quality control to ensure product safety and efficacy.