Emergency Medicine Book

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Carbon Monoxide Poisoning

Aka: Carbon Monoxide Poisoning
  1. Epidemiology
    1. Leading cause of toxin related death in United States
  2. Sources of Carbon Monoxide
    1. Gas powered engine
      1. Propane fueled forklifts
      2. Ice skating rink Zamboni
      3. Indoor tractor pulls
    2. Home
      1. Furnace
      2. Indoor Heaters
        1. Home water heaters
        2. Gas heaters
        3. Pool heaters
        4. Kerosene heaters
      3. Indoor Flames
        1. Wood stoves
        2. Indoor charcoal fires
        3. Sterno fuel
      4. Tobacco smoke
        1. Smokers
          1. Carboxyhemoglobin levels may reach 9-20%
        2. Nonsmokers exposed to passive smoke
          1. Cigarette tip 2.5 fold greater CO than inhaled
    3. Industrial or Occupational
      1. Steel foundry
      2. Pulp paper mill
      3. Formaldehyde and coke producing plants
      4. Fire fighters
    4. Fire
      1. Building or structure fire
      2. Wilderness fire
  3. Pathophysiology
    1. Carbon Monoxide Properties
      1. Colorless
      2. Odorless
      3. Non-irritating gas
    2. Carbon monoxide inhalation
      1. High affinity for Hemoglobin
      2. Displaces Oxygen and produces carboxyhemoglobin
    3. Results in excessive carboxyhemoglobin
  4. Symptoms
    1. Headache (88%)
    2. Dizziness (83%)
    3. Nausea (75%)
    4. Drowsiness (75%)
    5. Dry Mouth (44%)
  5. Signs
    1. Cherry-red skin and mucosa
    2. Bounding Pulse
    3. Hypertension
    4. Muscular fasciculations
    5. Stertorous breathing
    6. Dilated pupils
    7. Convulsions
    8. Altered mental state to coma
  6. Symptoms and Signs per Carboxyhemoglobin level
    1. Carboxyhemoglobin: 10%
      1. Frontal Headache
    2. Carboxyhemoglobin: 20%
      1. Throbbing Headache
      2. Dyspnea on exertion
    3. Carboxyhemoglobin: 30%
      1. Impaired judgment
      2. Nausea or Vomiting
      3. Dizziness
      4. Visual disturbance
      5. Fatigue
    4. Carboxyhemoglobin: 40%
      1. Confusion
      2. Syncope
    5. Carboxyhemoglobin: 50%
      1. Coma
      2. Seizures
    6. Carboxyhemoglobin: 60%
      1. Hypotension
      2. Respiratory failure
    7. Carboxyhemoglobin: 70%
      1. Death
  7. Labs
    1. Blood grossly appears abnormal red color
    2. Carboxyhemoglobin elevated
    3. Leukocytosis
  8. Management: Mild Poisoning
    1. Criteria
      1. Carboxyhemoglobin <30%
      2. No Neurologic or Cardiovascular Impairment
    2. Management
      1. Oxygen 100% Non-Rebreathing Mask
        1. Continue until carboxyhemoglobin <5%
      2. Admission criteria
        1. All patients with Carboxyhemoglobin >25%
        2. Underlying heart disease
  9. Management: Moderate Poisoning
    1. Criteria
      1. Carboxyhemoglobin: 30-40%
      2. No Neurologic Impairment
    2. Management
      1. Oxygen 100% Non-Rebreathing Mask
        1. Continue until carboxyhemoglobin <5%
      2. Admission to telemetry (cardiovascular monitor)
      3. Arterial Blood Gas
        1. Determine acid-base status
  10. Management: Severe Poisoning
    1. Criteria
      1. Carboxyhemoglobin: >40%
      2. Neurologic Impairment
    2. Management
      1. Oxygen 100% Non-Rebreathing Mask
        1. Continue until carboxyhemoglobin <5%
      2. Admission to telemetry (cardiovascular monitor)
      3. Arterial Blood Gas
        1. Follow acid-base status
      4. Hyperbaric oxygen chamber
        1. Efficacy
          1. Better short-term and long-term cognitive outcome
          2. Weaver (2002) N Engl J Med 347:1057-67
        2. Criteria
          1. Chamber immediately available OR
          2. No improvement in 4 hours
            1. Cardiovascular status
            2. Neurologic status
  11. Preventive Measures
    1. Adequate Ventilation
    2. Carbon monoxide detectors
  12. Resources
    1. Consumer Products Safety= 800-638-2772)
  13. References
    1. Reisdorf (1996) in Tintinelli (1996)
    2. (1995) MMWR Morb Mortal Wkly Rep 44:765-7

Carbon Monoxide Poisoning (C0007020)

Definition (MEDLINEPLUS)

Carbon monoxide (CO) is a gas that has no odor or color. But it is very dangerous. It can cause sudden illness and death. CO is found in combustion fumes, such as those made by cars and trucks, lanterns, stoves, gas ranges and heating systems. CO from these fumes can build up in places that don't have a good flow of fresh air. You can be poisoned by breathing them in. The most common symptoms of CO poisoning are

  • Headache
  • Dizziness
  • Weakness
  • Nausea
  • Vomiting
  • Chest pain
  • Confusion

It is often hard to tell if someone has CO poisoning, because the symptoms may be like those of other illnesses. People who are sleeping or intoxicated can die from CO poisoning before they have symptoms. A CO detector can warn you if you have high levels of CO in your home.

Centers for Disease Control and Prevention
Definition (MSH) Toxic asphyxiation due to the displacement of oxygen from oxyhemoglobin by carbon monoxide.
Definition (CSP) toxic asphyxiation due to the displacement of oxygen from oxyhemoglobin by carbon monoxide.
Concepts Injury or Poisoning (T037)
MSH D002249
SnomedCT 17383000
English Carbon Monoxide Poisonings, Monoxide Poisoning, Carbon, Monoxide Poisonings, Carbon, Poisoning, Carbon Monoxide, Poisonings, Carbon Monoxide, CARBON MONOXIDE POISONING, Carbon monoxide poisoning syndrome, POIS CARBON MONOXIDE, CARBON MONOXIDE POIS, carbon monoxide poisoning, CO poisoning, poisoning by carbon monoxide (diagnosis), poisoning by carbon monoxide, Carbon Monoxide Poisoning [Disease/Finding], carbon monoxide poison, carbon monoxide toxicity, CO Poisoning, Carbon Monoxide Poisoning, Carbon monoxide poisoning
Italian Intossicazione da monossido di carbonio, Avvelenamento da monossido di carbonio
Swedish Kolmonoxidförgiftning
Japanese ｲｯｻﾝｶﾀﾝｿﾁｭｳﾄﾞｸ, 中毒-一酸化炭素, 照明用ガス中毒, 灯用ガス中毒, CO中毒, 一酸化炭素中毒
Czech oxid uhelnatý - otrava, Otrava oxidem uhelnatým
Finnish Häkämyrkytys
Russian UGLERODA OKIS'IU OTRAVLENIE, SVETIL'NYM GAZOM OTRAVLENIE, СВЕТИЛЬНЫМ ГАЗОМ ОТРАВЛЕНИЕ, УГЛЕРОДА ОКИСЬЮ ОТРАВЛЕНИЕ
Portuguese Envenenamento por Monóxido de Carbono, Intoxicação por monóxido de carbono, Intoxicação por Monóxido de Carbono
Croatian OTROVANJE UGLJIČNIM MONOKSIDOM
Polish Zatrucie gazem świetlnym, Zatrucie tlenkiem węgla
Hungarian Szén-monoxid mérgezés
Spanish intoxicación por monóxido de carbono, Intoxicación por monóxido de carbono, Envenenamiento por Gas del Alumbrado, Envenenamiento por Monóxido de Carbono, Intoxicación por Monóxido de Carbono, Envenenamiento por Monoxido de Carbono, Intoxicacion por Monoxido de Carbono
Dutch koolmonoxidevergiftiging, Kolendampvergiftiging, Koolmonoxydevergiftiging, Vergiftiging, kolendamp-
French Intoxication par le monoxyde de carbone, Intoxication oxycarbonée, Intoxication au monoxyde de carbone, Intoxication par l'oxyde de carbone, Intoxication à l'oxyde de carbone, Oxycarbonisme
German Kohlenmonoxidvergiftung
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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