Lack of oxygen in the tissues may be due to respiratory or circulatory failure or absence of oxygen. Thus, the first situation may arise if a toxic compound affects breathing rate via central control, such as the drug dextropropoxyphene when taken in overdoses, or by effecting respiratory muscles such as Botulinum toxin. The second situation arises when a toxic compound inhibits oxygen transport. The classic example of this is carbon monoxide which binds to haemoglobin in place of oxygen (see Chapter 7 for more details). Another example is the oxidation of haemoglobin by nitrite; the methaemoglobin produced does not carry oxygen.

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