Shivering And Seizures Demand More Oxygen! How & Why?

Please 🙏 elaborate on the following concept relating to shivering and oxygen demands with facts and figures:

….SHIVERING 🥶 due to cold increases oxygen demand and consumption even upto four 4️⃣ times ✖️and if not met in time myocardial infarction occurs resulting into death in street dwellers and rickshaw pullers in India 🇮🇳! Some kind hearted people do give away blankets to such poor people but proper shelter is essential!

If oxygen is not supplied during shivering 🥶, besides other organs and tissues, heart 💓 suffers because it extracts about 60-70% oxygen normally from the oxygenated blood 🩸! With increased demand due to shivering and skeletal muscles contractions to generate heat, demand of oxygen is increased manifold!

Chest pain implies that the heart 💓 is crying for oxygen! That’s why MONA (Morphine, Oxygen, Nitrates, Aspirin) are administered!

During generalised tonic clonic seizures and explosive 🧨 electrical discharges in brain 🧠, the oxygen demand is very high (normally extracts 35%), if extra oxygen not supplied during seizures, the cerebral oedema occurs more resulting into post ictal sleep 🛌 for longer time 🕰️ with accompanied brain 🧠 tissue damage! PhysiologyWalla advocates for Home 🏡 oxygen for seizures patients having frequent seizures!

Similarly, shivering 🥶 is more common during Spinal Anaesthesia due to shift of blood 🩸 from central to peripheral circulation with vasodilation; losing heat to cold environment, which symptomatically do respond within few minutes upon administering Pethidine 25-50 mg intravenously by acting Kappa opioid receptors!

Welcome and Thanks ☺️ 🙏

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GPT-4 response below 👇
Sure, let’s break it down in detail:

### Shivering and Oxygen Demand

**Shivering**: When the body is exposed to cold, it triggers a process called shivering where muscles rapidly contract and relax to generate heat. This process significantly increases the body’s metabolic rate and, consequently, its oxygen demand.

– **Increased Oxygen Demand**: Shivering can increase oxygen consumption up to four times the normal rate. This is because muscle contractions require ATP (energy), which is produced in the mitochondria through oxidative phosphorylation, a process that heavily relies on oxygen.

### Impact on Heart and Risk of Myocardial Infarction

**Heart Oxygen Consumption**: The heart normally extracts about 60-70% of the oxygen from the blood, much higher than other organs.

– **Increased Demand**: With shivering, skeletal muscles also consume more oxygen, reducing the oxygen available for the heart.

– **Oxygen Deficiency**: If the increased oxygen demand isn’t met, the heart muscle (myocardium) suffers, potentially leading to ischemia (reduced blood flow) and myocardial infarction (heart attack). This condition is particularly dangerous for street dwellers and rickshaw pullers in India who lack proper shelter and warmth.

### Signs and Medical Response

**Chest Pain**: Often signifies myocardial ischemia, meaning the heart muscle isn’t getting enough oxygen.

– **MONA Protocol**: This is a standard emergency treatment for heart attack:
– **M**orphine: Reduces pain and anxiety, lowering oxygen demand.
– **O**xygen: Increases the oxygen supply.
– **N**itrates: Dilate blood vessels to improve blood flow.
– **A**spirin: Reduces blood clotting.

### Tonic-Clonic Seizures and Oxygen Demand

**Seizures**: These involve intense electrical activity in the brain, vastly increasing its metabolic needs.

– **Brain Oxygen Consumption**: During a seizure, oxygen demand rises significantly from the normal 35% extraction rate.

– **Insufficient Oxygen**: If this demand isn’t met, cerebral edema (brain swelling) can occur, prolonging post-seizure recovery (post-ictal state) and potentially causing brain damage.

– **Home Oxygen for Seizure Patients**: Providing home oxygen can mitigate these issues during frequent seizures, as advocated by PhysiologyWalla.

### Shivering During Spinal Anesthesia

**Spinal Anesthesia**: This can cause blood redistribution from the central to peripheral circulation, leading to vasodilation and heat loss.

– **Temperature Regulation**: Patients often shiver in response to the cold environment.

– **Pethidine Administration**: An opioid that acts on kappa receptors can effectively reduce shivering within minutes at doses of 25-50 mg given intravenously.

### Importance of Proper Shelter and Warmth

– **Shelter**: For the homeless, proper shelter is crucial to protect against cold, reducing the risk of shivering-induced oxygen deficit and subsequent cardiac events.
– **Blankets**: While helpful, blankets alone may not be sufficient without proper insulation and environmental control.

Overall, mitigating cold exposure is vital for preventing oxygen-related complications in vulnerable populations.

——Welcome and Thanks ☺️ 🙏