Citizendia

Carbon monoxide poisoning
Classification and external resources
Spacefilling model of Carbon monoxide. Carbon monoxide, with the chemical formula CO is a colorless odorless tasteless yet highly toxic Gas.
ICD-10T58.
ICD-9986
DiseasesDB2020
MedlinePlus002804
eMedicineemerg/817 
MeSHC21.613.455.245

Carbon monoxide poisoning occurs after the inhalation of carbon monoxide gas. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings S00-T14 - Injury (S00-S09 Head ( Superficial Injury of head ( Superficial injury of The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Carbon monoxide, with the chemical formula CO is a colorless odorless tasteless yet highly toxic Gas. Carbon monoxide (CO) is a product of combustion of organic matter under conditions of restricted oxygen supply, which prevents complete oxidation to carbon dioxide (CO2). Carbon dioxide ( Chemical formula:) is a Chemical compound composed of two Oxygen Atoms covalently bonded to a single Carbon monoxide is colorless, odorless, tasteless, and non-irritating, making it difficult for people to detect.

Carbon monoxide is a significantly toxic gas with poisoning being the most common type of fatal poisoning in many countries. [1] Symptoms of mild poisoning include headaches, vertigo, and flu-like effects; larger exposures can lead to significant toxicity of the central nervous system, heart and even death. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Following poisoning, long-term sequelae often occur. A sequela, (sɨˈkwiːlə plural sequelæ) is a Pathological condition resulting from a Disease, Injury, or other trauma. Carbon monoxide can also have severe effects on the fetus of a pregnant woman. A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and

The mechanisms by which carbon monoxide produces toxic effects are not yet fully understood, but hemoglobin, myoglobin, and mitochondrial cytochrome oxidase are thought to be compromised. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Myoglobin is a single-chain globular Protein of 153 Amino acids containing a Heme ( Iron -containing Porphyrin) Prosthetic The Enzyme cytochrome c oxidase or Complex IV () is a large Transmembrane protein complex found in Bacteria and the Mitochondrion Treatment largely consists of administering 100% oxygen or hyperbaric oxygen therapy, although the optimum treatment remains controversial. Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the Hyperbaric medicine, also known as hyperbaric oxygen therapy (HBOT is the medical use of Oxygen at a higher than Atmospheric pressure. [2] Domestic carbon monoxide poisoning can be prevented by early detection with the use of household carbon monoxide detectors. A carbon monoxide detector or CO detector is a device that detects the presence of the Toxic gas Carbon monoxide (CO a colorless and odorless compound

Contents

Sources

Common sources of CO that may lead to poisoning include house fires, furnaces or heaters, wood-burning stoves, motor vehicle exhaust, and propane-fueled equipment such as portable camping stoves, ice resurfacers,[3] forklifts,[4] engine-driven generators,[5] and gasoline-powered tools such as high-pressure washers, concrete cutting saws, power trowels, floor buffers, and welders used in buildings or semienclosed spaces. [6] CO poisoning can also occur in scuba diving due to faulty or badly sited diving air compressors. Scuba diving is swimming underwater, or taking part in another activity while using a Scuba set. A Diving Air Compressor is a Gas compressor that can fill Diving cylinders with high- Pressure Air pure enough to be used as a Breathing gas (See Effects of relying on breathing equipment while underwater for more information. Divers face specific physical and Health Risks when they go Underwater (e ) Generators and propulsion engines on boats --especially houseboats --have resulted in fatal carbon monoxide exposures. [7] Another source is exposure to the organic solvent methylene chloride, which is metabolized to CO by the body. Dichloromethane ( DCM) or methylene chloride is the Chemical compound with the formula CH2Cl2 [8]

Polluted air often contains unhealthy levels of carbon monoxide. Many areas of the US have struggled to achieve legislated limits. Significant advances have been made since the implementation by 1990 of a vehicle emissions limit of 3. 4 gpm (grams per mile), a large reduction from the previous limit of 87 gpm. [7] [8] [9] [10]

Epidemiology

Carbon monoxide poisoning is the most common type of fatal poisoning in France and the United States. It has been estimated that more than 40,000 people per year seek medical attention for carbon monoxide poisoning in the United States. [9] In many industrialized countries, carbon monoxide may be the cause of greater than 50% of fatal poisonings. [1] In the U. S. , about 200 people die each year from carbon monoxide poisoning associated with home fuel-burning heating equipment. [10] The CDC reports, "Each year, more than 500 Americans die from unintentional CO poisoning, and more than 2,000 commit suicide by intentionally poisoning themselves. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated "[11]

Suicide

As other poisons such as cyanide and arsenic were placed under increasingly stringent legal restrictions, the carbon monoxide in town gas became the principal method of suicide by poisoning. A cyanide is any Chemical compound that contains the cyano group (C≡N which consists of a Carbon Atom triple-bonded to a Suicide was also often committed by inhaling exhaust fumes of running car engines. In the past, motor car exhaust may have contained up to 25% carbon monoxide. Exhaust gas is Flue gas which occurs as a result of the Combustion of fuels such as Natural gas, Gasoline /petrol Diesel, Fuel Newer cars have catalytic converters, which can eliminate over 99% of carbon monoxide produced. A catalytic converter (colloquially "cat" or "catcon" is a device used to reduce the toxicity of emissions from an Internal combustion engine. [12] However, even cars with catalytic converters can produce substantial carbon monoxide if an idling car is left in an enclosed space. As carbon monoxide poisoning via car exhaust has become less of a suicide option, there has been an increase in new methods of carbon monoxide poisoning such as burning charcoal or other fossil fuels within a confined space, such as a small room, tent, or car. Charcoal-burning suicide is committing Suicide by burning Charcoal in a closed room [13] Such incidents have occurred mostly in connection with group suicide pacts in both Japan and Hong Kong, but are starting to occur in Western countries as well, such as the 2007 suicide of Boston lead singer Brad Delp. A suicide pact describes the Suicides of two or more individuals in an agreed-upon plan Boston is an American rock band from Boston Massachusetts that achieved its most notable successes during the 1970s and 1980s Bradley E Delp ( June 12 1951 &ndash March 9 2007) was an American Musician. [14]

Symptoms

Acute

The earliest symptoms, especially from low level exposures, are often non-specific and readily confused with other illnesses, typically flu-like viral syndromes, depression, chronic fatigue syndrome, chest pain, and migraine or other headaches. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Chronic fatigue syndrome ( CFS) is the most common name given to a poorly understood variably debilitating disorder or disorders of uncertain causation In Medicine, chest pain is a Symptom of a number of serious conditions and is generally considered a Medical emergency. Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea [15] This often makes the diagnosis of carbon monoxide poisoning difficult. If suspected, the diagnosis can be confirmed by measurement of blood carboxyhemoglobin. Carboxyhemoglobin (British English Carboxyhaemoglobin) (COHb is a stable complex of Carbon monoxide and Hemoglobin that forms in red Blood

The main manifestations of poisoning develop in the organ systems most dependent on oxygen use: the central nervous system and the heart. The clinical manifestations include tachycardia and hypertension, and central nervous system symptoms such as headache, dizziness, confusion, convulsions, and unconsciousness. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Many different terms are often used to describe what is collectively known as dizziness. Confusion, of a Pathological degree usually refers to loss of orientation (ability to place oneself correctly in the world by time location and personal identity and An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting CO poisoning may also produce myocardial ischemia, atrial fibrillation, pneumonia, pulmonary edema, hyperglycemia, muscle necrosis, acute renal failure, skin lesions, visual and auditory problems, and respiratory arrest. In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction Atrial fibrillation ( AF or afib) is a Cardiac arrhythmia (abnormal heart rhythm that involves the two upper chambers ( atria) of the Heart Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Rhabdomyolysis is the rapid breakdown ( Lysis) of Skeletal muscle tissue ( rhabdomyo) due to injury to muscle tissue Acute renal failure ( ARF) also known as acute kidney failure or acute kidney injury, is a rapid loss of Renal function due to damage to the Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. [16]

One of the major concerns following CO poisoning is the severe neurological manifestations that may occur days or even weeks after an acute poisoning. Common problems encountered are difficulty with higher intellectual functions and short-term memory, dementia, irritability, gait disturbance, speech disturbances, parkinson-like syndromes, cortical blindness, and depression[17] (depression can occur in those accidentally exposed). Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's Cortical blindness is the total or partial loss of vision in a normal-appearing Eye caused by damage to the visual area in the Brain 's Occipital cortex. In the fields of Psychology and Psychiatry, the terms depression or depressed refer to both expected and pathologically chronic or severe These delayed sequelae occur in approximately 15 percent of severely poisoned patients after an interval of 2 to 28 days. A sequela, (sɨˈkwiːlə plural sequelæ) is a Pathological condition resulting from a Disease, Injury, or other trauma. It is difficult to predict who may develop delayed sequelae; however, advancing age, loss of consciousness while poisoned, and initial neurological abnormalities may indicate a greater chance of developing delayed symptoms. According to the Philadelphia poison control hotline, sequelae are generally not anticipated when exposure is not severe enough to result in loss of consciousness.

Chronic

Long term, repeated exposures present a greater risk to persons with coronary heart disease and in pregnant patients. Coronary disease (or coronary heart disease) refers to the failure of Coronary circulation to supply adequate circulation to Cardiac muscle and surrounding [18] Chronic exposure may increase the incidence of cardiovascular symptoms in some workers, such as motor vehicle examiners, firefighters, and welders. Patients often complain of persistent headaches, lightheadedness, depression, confusion, and nausea. Upon removal from exposure, the symptoms usually resolve themselves. [19]

Toxicity

Carbon monoxide is a significantly toxic gas, although patients may demonstrate varied clinical manifestations with different outcomes, even under similar exposure conditions. [20] Toxicity is also increased by several factors, including: increased activity and rate of ventilation, pre-existing cerebral or cardiovascular disease, reduced cardiac output, anemia or other hematological disorders, decreased barometric pressure, and high metabolic rate. In Respiratory physiology, ventilation (or ventilation rate) is the rate at which gas enters or leaves the Lung. Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Basal metabolic rate ( BMR) is the amount of energy expended while at rest in a neutrally temperate environment in the post-absorptive state (meaning that the digestive system

Under ordinary conditions, it is less dense than air, but during fires, it accumulates on the ground, so that if poisoning causes loss of consciousness, the amount of carbon monoxide inhaled increases and the possibility of fatality is radically increased. Temperature and layers The temperature of the Earth's atmosphere varies with altitude the mathematical relationship between temperature and altitude varies among five

Carbon monoxide is life-threatening to humans and other aerobic forms of life, as inhaling even relatively small amounts of it can lead to hypoxic injury, neurological damage, and possibly death. Human beings, humans or man (Origin 1590–1600 L homō man OL hemō the earthly one (see Humus Life is a state that distinguishes Organisms from non-living objects such as non-life and dead organisms being manifested by growth through Metabolism A concentration of as little as 0. 04% (400 parts per million) carbon monoxide in the air can be fatal. The gas is especially dangerous because it is not easily detected by human senses. Early symptoms of carbon monoxide poisoning include drowsiness and headache, followed by unconsciousness, respiratory failure, and death. First aid for a victim of carbon monoxide poisoning requires access to fresh air; administration of artificial respiration and, if available, oxygen; and, as soon as possible, medical attention.

When carbon monoxide is inhaled, it takes the place of oxygen in hemoglobin, the red blood pigment that normally carries oxygen to all parts of the body. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Because carbon monoxide binds to hemoglobin several hundred times more strongly than oxygen, its effects are cumulative and long-lasting, causing oxygen starvation throughout the body. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate Prolonged exposure to fresh air (or pure oxygen) is required for the CO-tainted hemoglobin (carboxyhemoglobin) to clear. Carboxyhemoglobin (British English Carboxyhaemoglobin) (COHb is a stable complex of Carbon monoxide and Hemoglobin that forms in red Blood

The effects of carbon monoxide in parts per million are listed below:

In addition, a recent report concludes that carbon monoxide exposure can lead to significant loss of lifespan after exposure due to damage to the heart muscle. Myocardium is the muscular tissue of the Heart. Relationship to other layers The other tissues of the heart are the Endocardium [21]

Carboxyhemoglobin

Levels of carbon monoxide bound in the blood can be determined by measuring carboxyhemoglobin, which is a stable complex of carbon monoxide and hemoglobin that forms in red blood cells. Carboxyhemoglobin (British English Carboxyhaemoglobin) (COHb is a stable complex of Carbon monoxide and Hemoglobin that forms in red Blood Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Carbon monoxide is produced normally in the body, establishing a low background carboxyhemoglobin saturation. Carbon monoxide also functions as a neurotransmitter. See Chemical synapse for an introduction to concepts and terminology used in this article Normal carboxyhemoglobin levels in an average person are less than 5%, whereas cigarette smokers (two packs/day) may have levels up to 9%. [22]

Serious toxicity is often associated with carboxyhemoglobin levels above 25%, and the risk of fatality is high with levels over 70%. Still, no consistent dose response relationship has been found between carboxyhemoglobin levels and clinical effects. [23] Therefore, carboxyhemoglobin levels are more guides to exposure levels than effects as they do not reliably predict clinical course or short- or long-term outcome. [24]

Toxic mechanism

The precise mechanisms by which toxic effects are induced by CO are not fully understood.

Carbon monoxide binds to hemoglobin (reducing oxygen transportation), myoglobin (decreasing its oxygen storage capacity), and mitochondrial cytochrome oxidase (inhibiting cellular respiration). Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Myoglobin is a single-chain globular Protein of 153 Amino acids containing a Heme ( Iron -containing Porphyrin) Prosthetic The Enzyme cytochrome c oxidase or Complex IV () is a large Transmembrane protein complex found in Bacteria and the Mitochondrion

Hemoglobin

Carbon monoxide has a significant affinity to the iron sites in hemoglobin, the principal oxygen-carrying compound in blood. The affinity between carbon monoxide and hemoglobin is 240 times stronger than the affinity between hemoglobin and oxygen.

CO binds to hemoglobin, producing carboxyhemoglobin (COHb) - the traditional belief is that carbon monoxide toxicity arises from the formation of carboxyhemoglobin, which decreases the oxygen-carrying capacity of the blood. Carboxyhemoglobin (British English Carboxyhaemoglobin) (COHb is a stable complex of Carbon monoxide and Hemoglobin that forms in red Blood This inhibits the transport, delivery, and utilization of oxygen. [25] Because hemoglobin is a tetramer with four oxygen binding sites, binding of CO at one of these sites also increases the oxygen affinity of the remaining 3 sites, which interferes with normal release of oxygen. A tetramer is a Protein with four subunits (tetrameric There are homo-tetramers (all Subunits are identical such as Glutathione S-transferase or This causes hemoglobin to retain oxygen that would otherwise be delivered to the tissue. [26]

Levels of oxygen available for tissue use are decreased. This situation is described as CO shifting the oxygen dissociation curve to the left. The oxygen-haemoglobin dissociation curve plots the proportion of Hemoglobin in its saturated form on the vertical axis against the prevailing Oxygen tension on the Blood oxygen content is actually increased in the case of carbon monoxide poisoning; because all the oxygen is in the blood, none is being given to the tissues, and this causes tissue hypoxic injury. However, despite CO affecting oxygen availability, other mechanisms may contribute to the crucial effects of CO poisoning.

A sufficient exposure to carbon monoxide can reduce the amount of oxygen taken up by the brain to the point that the victim becomes unconscious, and can suffer brain damage or even death from hypoxia. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate The brain regulates breathing based upon carbon dioxide levels in the blood, rather than oxygen levels, so a victim can succumb to hypoxia without ever noticing anything up to the point of collapse. Carbon dioxide ( Chemical formula:) is a Chemical compound composed of two Oxygen Atoms covalently bonded to a single Hallmark pathological change following CO poisoning is bilateral necrosis of the pallidum. The globus pallidus ( Latin for "pale globe" is a sub- cortical structure of the Brain.

Hemoglobin acquires a bright red color when converted to carboxyhemoglobin, so a casualty of CO poisoning is described in textbooks as looking pink-cheeked and healthy. However, this "classic" cherry-red appearance is not always seen in living patients [27] — in one study it was noted in only 2% of cases — so care should be taken not to overlook the diagnosis even if this color is not present. It is often only seen once HbCO levels reach 40% and such patients usually die.

Myoglobin

Carbon monoxide also has a high affinity for myoglobin. Myoglobin is a single-chain globular Protein of 153 Amino acids containing a Heme ( Iron -containing Porphyrin) Prosthetic CO bound to myoglobin may impair cardiac output and result in cerebral ischemia. A delayed return of symptoms has been reported and appears to result following a recurrence of increased carboxyhemoglobin levels; this effect may be due to late release of CO from myoglobin, which subsequently binds to hemoglobin. [1]

Cytochrome oxidase

A second mechanism involves co-effects on the mitochondrial respiratory enzyme chain that is responsible for effective tissue utilization of oxygen. CO does not bind to cytochrome oxidase with the same affinity as oxygen, so it likely requires significant intracellular hypoxia before binding. The Enzyme cytochrome c oxidase or Complex IV () is a large Transmembrane protein complex found in Bacteria and the Mitochondrion This binding interferes with aerobic metabolism and efficient adenosine triphosphate (ATP) synthesis. Adenosine-5'-triphosphate ( ATP) is a multifunctional Nucleotide that is most important as a " molecular currency" of intracellular Energy Cells respond by switching to anaerobic metabolism, causing anoxia, lactic acidosis, and eventual cell death. [28]

Other mechanisms

Another mechanism that is thought to have a significant influence on delayed effects involves formed blood cells and chemical mediators, which cause brain lipid peroxidation.

CO causes endothelial cell and platelet release of nitric oxide, and the formation of oxygen free radicals including peroxynitrite. Nitric oxide or nitrogen monoxide is a Chemical compound with Chemical formula N[[Oxygen O]] In Chemistry, radicals (often referred to as free radicals) are atoms molecules or ions with Unpaired electrons on an otherwise Open shell [23] In the brain, this causes further mitochondrial dysfunction, capillary leakage, leukocyte sequestration, and apoptosis. Capillaries are the smallest of a body's Blood vessels measuring 5-10 μm in diameter which connect Arterioles and Venules and enable the interchange [29] The end result is lipid peroxidation (degradation of unsaturated fatty acids), which causes delayed reversible demyelinization of white matter in the central nervous system, and can lead to edema and focal areas of necrosis within the brain. White matter is one of the three main solid components of the Central nervous system. Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. [26]

This brain damage occurs mainly during the recovery period and results in cognitive defects (especially affecting memory and learning) and movement disorders. The movement disorders are related to a predilection of CO to damage the basal ganglia. The basal ganglia (or basal nuclei) are a group of nuclei in the Brain interconnected with the Cerebral cortex, Thalamus and [29] These delayed neurological effects may develop over days following the initial acute poisoning.

Pregnancy

Carbon monoxide poisoning can have significant fetal effects. A fetus (or foetus or fœtus) is a developing Mammal or other Viviparous Vertebrate, after the Embryonic stage and CO causes fetal tissue hypoxia by decreasing the release of maternal oxygen to the fetus, and by carbon monoxide crossing the placenta and combining with fetal hemoglobin, which has a 10 to 15% higher affinity for CO than adult hemoglobin. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate The placenta is an Ephemeral organ present in placental Vertebrates, such as Eutherial Mammals and Sharks during Gestation [1] Elimination of carbon monoxide is also slower in the fetus, leading to an accumulation of CO. The level of fetal morbidity and mortality in acute carbon monoxide poisoning is significant, so despite maternal wellbeing, severe fetal poisoning can still occur. Due to these effects, pregnant patients are treated with normal or hyperbaric oxygen for longer periods of time than non-pregnant patients.

Treatment

First aid for carbon monoxide poisoning is to immediately remove the victim from the exposure without endangering oneself, call for help, and begin CPR if needed. First aid is the provision of initial care for an Illness or Injury. The main medical treatment for carbon monoxide poisoning is breathing 100% oxygen by a tight fitting oxygen mask. Oxygen (from the Greek roots ὀξύς (oxys (acid literally "sharp" from the taste of acids and -γενής (-genēs (producer literally begetteris the An oxygen mask provides a method to transfer breathing Oxygen gas from a storage tank to the Lungs. Oxygen hastens the dissociation of carbon monoxide from hemoglobin, improving tissue oxygenation by reducing its biological half-life. Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Hyperbaric oxygen is also used in the treatment of CO poisoning; hyperbaric oxygen also increases carboxyhemoglobin dissociation and does so to a greater extent than normal oxygen. Hyperbaric medicine, also known as hyperbaric oxygen therapy (HBOT is the medical use of Oxygen at a higher than Atmospheric pressure. Hyperbaric oxygen may also facilitate the dissociation of CO from cytochrome oxidase.

A significant controversy in the medical literature is whether or not hyperbaric oxygen actually offers any extra benefits over normal high flow oxygen in terms of increased survival or improved long term outcomes. There have been clinical trials[24][30][31][32][33][34] in which the two treatment options have been compared; of the six performed, four found hyperbaric oxygen improved outcome and two found no benefit for hyperbaric oxygen. Some of these trials have been criticized for apparent flaws in their implementation. [35][36][37] A recent robust review of all the literature on carbon monoxide treatment concluded that the role of hyperbaric oxygen is unclear and the available evidence neither confirms nor denies a clinically meaningful benefit. The authors suggested a large, well designed, externally audited, multicentre trial to compare normal oxygen with hyperbaric oxygen. [2]

Further specific treatment for other complications such as seizure, cardiac abnormalities, pulmonary edema, and acidosis may be required. An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause Acidosis is an increased Acidity (ie an increased Hydrogen ion Concentration) The delayed development of neuropsychiatric impairment is one of the most serious complications of poisoning, with extensive follow up and treatment often being required.

Prevention

Prevention remains a vital public health issue, requiring public education on the safe operation of appliances, heaters, fireplaces, and internal-combustion engines, as well as increased emphasis on the installation of carbon monoxide detectors. A carbon monoxide detector or CO detector is a device that detects the presence of the Toxic gas Carbon monoxide (CO a colorless and odorless compound Carbon monoxide alarms are usually installed in homes around heaters and other equipment. If a high level of CO is detected, the device sounds an alarm, giving people in the area a chance to ventilate the area or safely leave the building. Unlike smoke detectors, they do not need to be placed near ceiling level. A smoke detector is a device that detects Smoke and issues an Alarm. The Consumer Product Safety Commission says that "carbon monoxide detectors are as important to home safety as smoke detectors are," and recommends that each home should have at least one carbon monoxide detector. The United States Consumer Product Safety Commission (U S CPSC is an independent agency of the U [38]

The devices, which retail for USD$20-$60 and are widely available, can either be battery-operated or AC powered (with or without a battery backup). The United States dollar ( sign: $; code: USD) is the unit of Currency of the United States; it has also been Since CO is colorless and odorless (unlike smoke from a fire), detection in a home environment is impossible without such a warning device. Some state and municipal governments, including those of Ontario, Canada, and New York City, require installation of CO detectors in new units. Ontario (ɒnˈtɛrioʊ is a province located in the central part of Canada, the largest by population and second largest after Quebec The City of New York Massachusetts and Illinois began to require a detector in all residences on January 1, 2007. The Commonwealth of Massachusetts ( is a state located in the New England region of the northeastern United States. The State of Illinois ( roughly ill-i-NOY is a state of the United States of America, the 21st to be admitted to the Union. [39][40]

The carbon monoxide can be easily detected by the filtering paper impregnated by the solution of the palladium chloride. In Chemistry, a solution is a Homogeneous Mixture composed of two or more substances Submit WARNING template loop detected to get this template --> Palladium(II chloride, also known as palladium dichloride, are the Chemical compounds Carbon monoxide reduces the palladium chloride to the black metallic palladium. Palladium (pronounced \pəˈleɪdiəm\ is a rare and lustrous silvery-white metal that was discovered in 1803 by William Hyde Wollaston, who named it palladium after the This reaction is very sensitive.

Carbon monoxide poisoning and "haunted houses"

Symptoms of carbon monoxide poisoning include listlessness, depression, dementia, emotional disturbances, and hallucinations. Many of the phenomena generally associated with haunted houses, including strange visions and sounds, feelings of dread, illness, and the sudden, apparently inexplicable death of all the occupants, can be readily attributed to carbon monoxide poisoning. A haunted house is defined as a house that is believed to be a center for Supernatural occurrences or Paranormal phenomena

In one famous case, carbon monoxide poisoning was clearly identified as the cause of an alleged haunting. Dr. William Wilmer, an ophthalmologist, described the experiences of one of his patients in a 1921 article published in the American Journal of Ophthalmology. Ophthalmology is the branch of Medicine which deals with the diseases and surgery of the visual pathways including the Eye, Brain Year 1921 ( MCMXXI) was a Common year starting on Saturday (link will display full 1921 calendar of the Gregorian calendar "Mr. and Mrs. H. " moved into a new home, but soon began to complain of headaches and fatigue. They began to hear bells and footsteps during the night, accompanied by strange physical sensations and sightings of mysterious figures. When they began to investigate the symptoms, they discovered the previous residents of the house had similar experiences. An examination of their furnace found it to be severely damaged, resulting in incomplete combustion and forcing most of the fumes (including carbon monoxide) into the house rather than up the chimney. Combustion or burning is a complex sequence of Exothermic chemical reactions between a Fuel and an Oxidant accompanied by the production of [41]

A report published in 2005 described a 23-year old female victim of carbon monoxide poisoning, found delirious and hyperventilating, who saw a "ghost" while in the shower. A new gas water heater had just been installed in her home, apparently improperly, which flooded the house with carbon monoxide when the victim closed all the exterior windows and doors and took a shower. [42]

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  38. ^ Carbon Monoxide Detectors Can Save Lives
  39. ^ Massachusetts General Laws, Chapter 148, Section 26F 1/2. Also known as "Nicole's Bill". Enacted November 4, 2005.
  40. ^ Illinois Public Act 094-0741. Effective 01/01/2007.
  41. ^ A True Tale Of A Truly Haunted House by Albert Donnay
  42. ^ Jiann-Ruey Ong, Sheng-Wen Hou, Hsien-Tsung Shu, Huei-Tsair Chen, and Chee-Fah Chong. Diagnostic pitfall: carbon monoxide poisoning mimicking hyperventilation syndrome. The American Journal of Emergency Medicine Volume 23, Issue 7 , November 2005, Pages 903-904

See also

External links

A carbon monoxide detector or CO detector is a device that detects the presence of the Toxic gas Carbon monoxide (CO a colorless and odorless compound Hypercapnia or hypercapnea (from the Greek hyper = "above" and kapnos = " Smoke " also known as hypercarbia is The Undersea and Hyperbaric Medical Society ( UHMS) is the primary source of information for diving and hyperbaric medicine physiology worldwide
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