These include breathlessness, an increased rate of breathing, use of the chest and abdominal muscles to breathe, and lip pursing. : 642 Chronic hypoxemia may be compensated or uncompensated. The compensation may cause symptoms to be overlooked initially, however, further disease or a stress such as any increase in oxygen demand may finally unmask the existing hypoxemia. In a compensated state, blood vessels supplying less-ventilated areas of the lung may selectively contract, to redirect the blood to areas of the lungs which are better ventilated. However, in a chronic context, and if the lungs are not well ventilated generally, this mechanism can result in pulmonary hypertension, overloading the right ventricle of the heart and causing cor pulmonale and right sided heart failure. Polycythemia can also occur. In children, chronic hypoxemia may manifest as delayed growth, neurological development and motor development and decreased sleep quality with frequent sleep arousals.Other symptoms of hypoxemia may include cyanosis, digital clubbing, and symptoms that may relate to the cause of the hypoxemia, including cough and hemoptysis. : 642 Serious hypoxemia typically occurs when the partial pressure of oxygen in blood is less than 60 mmHg (8.0 kPa), the beginning of the steep portion of the oxygen–hemoglobin dissociation curve, where a small decrease in the partial pressure of oxygen results in a large decrease in the oxygen content of the blood. Severe hypoxia can lead to respiratory failure

Causes
Hypoxemia refers to insufficient oxygen in the blood.
The external partial pressure of oxygen decreases with altitude, for example in areas of high altitude or when flying. This decrease results in decreased carriage of oxygen by hemoglobin. This is particularly seen as a cause of cerebral hypoxia and mountain sickness in climbers of Mount Everest and other peaks of extreme altitude. For example, at the peak of Mount Everest, the partial pressure of oxygen is just 43 mmHg, whereas at sea level the partial pressure is 150 mmHg. For this reason, cabin pressure in aircraft is maintained at 5,000 to 6,000 feet (1500 to 1800 m). Diving. Hypoxia in diving can result from sudden surfacing. The partial pressures of gases increases when diving by one ATM every ten metres. This means that a partial pressure of oxygen sufficient to maintain good carriage by hemoglobin is possible at depth, even if it is insufficient at the surface. A diver that remains underwater will slowly consume their oxygen, and when surfacing, the partial pressure of oxygen may be insufficient (shallow water blackout). This may manifest at depth as deep water blackout. Suffocation. Decreased concentration of oxygen in inspired air caused by reduced replacement of oxygen in the breathing mix. Anaesthetics. Low partial pressure of oxygen in the lungs when switching from inhaled anesthesia to atmospheric air, due to the Fink effect, or diffusion hypoxia. Air depleted of oxygen has also proven fatal. In the past, anesthesia machines have malfunctioned, delivering low-oxygen gas mixtures to patients.