Happy Hypoxia- Everything you need to know about this new silent killer

By Dr Hirenappa Udnur, Consultant- Pulmonologist, Columbia Asia Hospital Hebbal (A unit of Manipal Hospitals)

The second wave of the Covid-19 pandemic has paved the way for some severe lung infections as well as new terms to explain the conditions. ‘Happy Hypoxia’ is one of them. It is the term used in a condition where oxygen levels in the blood decrease drastically but the patient remains happy and comfortable without any distress for the initial hours.  As this happens, a person may not experience dyspnea or breathlessness at the onset. By the time their body present symptoms, internal damage would have occurred.

In a healthy person, the normal oxygen level is above 95%. A further decrease in blood oxygen levels can be life threatening if there is no medical intervention immediately. Some Covid-19 patients show blood oxygen levels lower than 60%. Normally, when oxygen level goes low patient will go in distress. Heartbeat and respiratory rate will become high. They will become agitated and restless. This does not happen in some covid positive patients as soon as there is a dip in the oxygen level. For some time in the beginning, they will go about living their normal lives, as there are no signs of their lungs being in poor condition also no manifestation of symptoms in the body. Hence, patients suffering from Happy Hypoxia will not be able to self-diagnose the condition in the early stages. In such situations, if there is no immediate medical attention, there is a high chance of the failure of organs such as the kidneys, heart and brain.

Comorbidities that can increase the condition

There could be multiple reasons for the decrease in oxygen levels. In some cases, secondary kidney diseases or lung aspiration can also lead into this condition. In certain Covid-19 cases, it can cause an inflammatory reaction in the body which then leads to clotting, in the blood vessels of the heart or lungs. This blocks the oxygen from reaching the tissues and cells of the lungs.

Identifying the condition

At hospitals, doctors use blood gas analysis to determine the oxygen levels in blood. At home during quarantine, Happy Hypoxia is not easily identifiable as it does not show any noticeable or alarming signs. It is crucial to self-check the oxygen levels using the Oximeter, at regular intervals of time. One must also keep an eye on the points below:

• Colour of the lips/palms may change to blue.
• Sweating profusely after being involved in very little physical activity.
• Shortness of breath
• Slow heart rate
• Wheezing

It is crucial to consult a doctor immediately, if one notice that their blood oxygen level falls below 95% while checking with an oximeter. The doctor would initiate a physical examination of the lungs and heart, to diagnose the condition, and especially check to see if the skin has turned blue due to insufficient supply of oxygen. 

The doctor would also want to check oxygen levels by using a pulse oximeter or an arterial blood gas test, which is done by taking a blood sample from the artery. The doctor might also check oxygen levels by fitting in breathing tubes connected to a machine.

Treatment

The fundamental principle in treating Happy Hypoxia condition is to raise the blood oxygen levels. In covid patients gradually the virus replicates and goes down from the throat to lungs, and causes pneumonia. If the infection involves the airway in lungs, doctors often give medications through inhalers and the condition improves. This is done to treat the underlying conditions that cause Happy Hypoxia. 

 In more severe cases, the doctor may prescribe oxygen therapy, which is giving people extra oxygen, usually through a tube called ‘Cannula’. If a life is in danger or if the person is not responding to other treatments, the next best option would be to provide them machine support to breathe. The amount of time a person requires oxygen therapy varies from case to case. Depending on the seriousness of the situation, the patient may receive oxygen at home, with a portable machine while they travel, or in the hospital.

Complications or side effects 

If the oxygen levels in the blood are declining, the body would fail to deliver adequate supply of oxygen to all tissues and organs. This can lead to the shutting down of organs such as the heart, brain, kidneys and can result in death if medical help is not sought immediately. 

Be vigilant and prepared

The best way to prevent the condition of Happy Hypoxia would be to keep monitoring the oxygen levels using a pulse oximeter at regular intervals. Make sure to do this even if the patient is fine and not experiencing any discomfort.

Eating healthy and staying physically active is also important to prevent this condition. It is essential to identify one’s asthma triggers, to prepare themselves and find ways to prevent them. For people using inhalers, consult your doctor and take additional medication to prevent any flares.