Carbon Monoxide Poisoning
Carbon monoxide (CO) poisoning occurs when carbon monoxide gas is inhaled. CO is a colorless, odorless, highly poisonous gas. It is found in automobile exhaust fumes, faulty stoves and heating systems, fires, and cigarette smoke. Other sources include woodburning stoves, kerosene heaters, improperly ventilated water heaters and gas stoves, and blocked or poorly maintained chimney flues. CO interferes with the ability of the blood to carry oxygen. The result is headache, nausea, convulsions, and finally death by asphyxiation.
Carbon monoxide, sometimes called coal gas, has been known as a toxic substance since the third century B.C. It was used for executions and suicides in early Rome. Today it is the leading cause of accidental poisoning in the United States. According to the Journal of the American Medical Association, 1,500 Americans die each year from accidental exposure to CO, and another 2,300 from intentional exposure (suicide). An additional 10,000 people seek medical attention after exposure to CO and recover.
Anyone who is exposed to CO will become sick, and the entire body is involved in CO poisoning.. A developing fetus can also be poisoned if a pregnant woman breathes CO gas. Infants, people with heart or lung disease, or those with anemia may be more seriously affected. People who are exposed to car exhausts in a confined area, such as underground parking garage attendants, are more likely to be poisoned by CO. Firemen also run a higher risk of inhaling CO.
The symptoms of CO poisoning in order of increasing severity include: headache, shortness of breath, dizziness, fatigue, mental confusion and difficulty thinking, loss of fine hand-eye coordination, nausea and vomiting, rapid heart rate, hallucinations, inability to execute voluntary movements accurately, collapse, lowered body temperature (hypothermia), coma, convulsions, seriously low blood pressure, cardiac and respiratory failure, and death
In some cases, the skin, mucous membranes, and nails of a person with CO poisoning are cherry red or bright pink. Because the color change doesn't always occur, it is an unreliable symptom to rely on for diagnosis.
Although most CO poisoning is acute, or sudden, it is possible to suffer from chronic, or long-term, CO poisoning. This condition exists when a person is exposed to low levels of the gas over a period of days to months. Symptoms are often vague and include (in order of frequency) fatigue, headache, dizziness, sleep disturbances, cardiac symptoms, apathy, nausea, and memory disturbances. Little is known about chronic CO poisoning, and it is often misdiagnosed.
The main reason to suspect CO poisoning is evidence that fuel is being burned in a confined area, for example a car running inside a closed garage, a charcoal grill burning indoors, or an unvented kerosene heater in a workshop. Under these circumstances, one or more persons suffering from the symptoms listed above strongly suggests CO poisoning. In the absence of some concrete reason to suspect CO poisoning, the disorder is often misdiagnosed as migraine headache, stroke, psychiatric illness, food poisoning, alcohol poisoning, or heart disease.
The presence and extent of CO poisoning is confirmed through various blood tests, including a carboxyhemoglobin test. arterial blood gases and pH, a complete blood count, and measurement of other blood components such as sodium, potassium, bicarbonate, urea nitrogen, and lactic acid. An electrocardiogram (ECG) and a chest x ray may also be performed.
Victims of CO poisoning should be immediately removed from the source of carbon monoxide gas into fresh air. If the victim is not breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be started. Depending on the severity of the poisoning, 100% oxygen may be given with a tight fitting mask as soon as it is available.
Once a patient with CO poisoning is hospitalized, fluids and electrolytes may be administered to correct blood imbalances. In severe cases of CO poisoning, patients are given hyperbaric oxygen therapy. This treatment involves placing the patient in a pressurized chamber breathing 100% oxygen. The increased pressure forces more oxygen into the blood.
The speed and degree of recovery from CO poisoning depends on the length of exposure to the gas. Although the symptoms of CO poisoning may subside in a few hours, some patients show memory problems, fatigue, confusion, and mood changes for two to four weeks after their exposure to the gas.
Carbon monoxide poisoning is preventable. Particular care should be paid to situations where fuel is burned in a confined area. Portable and permanently installed carbon monoxide detectors that sound a warning similar to smoke detectors are available for under $50.
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