Understand the risks of carbon monoxide poisoning. Learn symptoms and prevention. Your guide to safety on Meri Sehat.

Carbon Monoxide Poisoning

A. JABBAR DENTAL CLINIC

Sadia Khan

Overview

Carbon monoxide poisoning is a life-threatening condition that occurs when an individual inhales high levels of carbon monoxide gas. 
&nbsp;

Carbon monoxide (CO) is a colorless, odorless, and tasteless gas. It is produced by the incomplete combustion of fuels such as gasoline, natural gas, coal, and kerosene.

CO poisoning can occur in various settings, including residential homes, workplaces, and vehicles, with common sources being stoves, grills, water heaters, and cars and trucks. More than one-third of deaths related to CO poisoning occur during sleep.<a href="#accordion">[1]</a>

Inhaling the gas is dangerous because CO binds to hemoglobin in the blood, reducing its ability to carry oxygen to the body&#39;s tissues and organs. This lack of oxygen leads to cellular damage and death.

A study conducted in Nigeria found that healthcare personnel dealing with CO poisoning cases had little to no knowledge about the condition, highlighting the need for education and awareness not only among the masses but also among medical professionals.<a href="#accordion">[2]</a>

At least 420 individuals in the US die from accidental CO poisoning each year.<a href="#accordion">[3]</a> According to a study, around 4.6 deaths per million happen worldwide due to CO poisoning. Men, in particular, are twice as likely to die due to CO poisoning as women.

Overall, the global incidence has remained stable, while the mortality rate has significantly declined by 36% over the last 25 years.<a href="#accordion">[4]</a> 
&nbsp;

There are two main types of CO poisoning &ndash; acute and chronic.<a href="#accordion">[5]</a>

<ul>
	<li>Acute Carbon Monoxide Poisoning: It&rsquo;s a case of a single, large exposure to CO, involving one or more people, and immediately reported to the doctor.</li>
	<li>Chronic Carbon Monoxide Poisoning: It&rsquo;s a case wherein the patient is exposed to CO on multiple occasions, though relatively in low concentrations of the gas. 
	&nbsp;</li>
</ul>

Sign and Symptoms

The symptoms of CO poisoning can range from mild, flu-like symptoms to severe neurological impairment and even death.

The severity of symptoms depends on the concentration of CO upon exposure, the duration of exposure, the time elapsed after exposure, and the patient&rsquo;s metabolic rate and response to oxygen therapy treatment.

<ul>
	<li><a href="https://merisehat.pk/disease/tension-headaches">Headache</a>, accompanied by dizziness or lightheadedness</li>
	<li>Nausea and vomiting</li>
	<li>Fatigue and weakness</li>
	<li>Difficulty concentrating and impaired judgment</li>
	<li>Shortness of breath</li>
	<li>Blurred vision</li>
	<li>Loss of consciousness 
	&nbsp;</li>
</ul>

Note: These symptoms can be similar to those of other illnesses. Seek medical attention immediately if you suspect CO poisoning. 
&nbsp;

Causes

The most common causes of CO poisoning include:<a href="#accordion">[6]</a>

<ul>
	<li>Malfunctioning or poorly maintained heating systems, such as furnaces, water heaters, and gas stoves</li>
	<li>Fuel-burning appliances, such as generators, grills, and portable stoves, used in enclosed or poorly ventilated spaces</li>
	<li>Auto exhaust or idling vehicles</li>
	<li>Fires </li>
	<li>Tobacco smoke 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of carbon monoxide poisoning is based on a combination of clinical symptoms, a history of exposure, and laboratory tests.<a href="#accordion">[1][6][7]</a>

<ul>
	<li>A physical exam may help observe changes in the patient&rsquo;s mental state.</li>
	<li>A blood test can determine the percentage of carboxyhemoglobin (COHb), which is formed when CO binds to hemoglobin in the blood. </li>
	<li>Other diagnostic tests include neurological tests, imaging scans (e.g., chest X-ray, MRI or CT scan of the brain), electrocardiogram, and direct oximetry. 
	&nbsp;</li>
</ul>

Treatment

In cases of suspected carbon monoxide poisoning, it is important to remove the individual from the source of exposure and provide them with fresh air. Prompt medical evaluation and treatment are essential to prevent further complications.

The primary treatment is the administration of 100% oxygen through a mask. In severe cases, however, hyperbaric oxygen therapy (HBOT) may be considered. It involves inhaling 100% oxygen in a pressurized total body chamber, which helps to rapidly eliminate CO from the body and increase the oxygen-carrying capacity of the blood.

Additionally, supportive care may be provided to manage symptoms and complications. This includes intravenous fluids, medications to treat nausea or headaches, and monitoring of vital signs and oxygen levels. 
&nbsp;

Complications of CO poisoning include:<a href="#accordion">[8]</a>

<ul>
	<li>Memory loss</li>
	<li>Parkinson&rsquo;s disease</li>
	<li>Heart abnormalities </li>
	<li>Breathing difficulties</li>
	<li>Abnormal fetal development or miscarriage</li>
	<li>Death 
	&nbsp;</li>
</ul>

Certain factors can increase the risk of carbon monoxide poisoning, including:

<ul>
	<li>Poorly Ventilated Spaces &ndash; Use of fuel-burning appliances in enclosed spaces such as basements, garages, and tents</li>
	<li>Smoking &ndash; Exposure to first-hand or second-hand smoke </li>
	<li>Age And Health Conditions &ndash; Infants, children, elderly, men, pregnant women, and individuals with pre-existing lung or heart disease</li>
	<li>Other &ndash; Drugged or asleep individuals 
	&nbsp;</li>
</ul>

There are several precautionary measures to prevent CO poisoning, including:

<ul>
	<li>Installation of CO detectors in homes and other enclosed spaces.</li>
	<li>Regular inspection and maintenance of heating systems, including furnaces, water heaters, and gas stoves, especially before the start of winter.</li>
	<li>Do not use fuel-burning appliances, such as generators and grills, indoors or in enclosed spaces.</li>
	<li>Avoid idling vehicles in enclosed spaces, such as garages, even if the outside door is open. 
	&nbsp;</li>
</ul>

key points

<ul>
	<li>Carbon monoxide (CO) poisoning is a life-threatening condition that occurs when an individual inhales high levels of carbon monoxide gas. </li>
	<li>There are two main types of CO poisoning &ndash; acute and chronic.</li>
	<li>Common symptoms of CO poisoning include headaches, nausea, fatigue, impaired judgment, shortness of breath, and loss of consciousness.</li>
	<li>The most common causes of CO poisoning include faulty heating systems, improper use of fuel-burning appliances, vehicle exhaust, fires, and tobacco smoke.</li>
	<li>Treatment of CO poisoning involves the administration of 100% oxygen and, in severe cases, hyperbaric oxygen therapy.</li>
	<li>Complications of CO poisoning can include memory loss, heart abnormalities, miscarriage, and death.</li>
	<li>Risk factors for CO poisoning include poorly ventilated spaces, smoking, age, and certain health conditions.</li>
	<li>Preventive measures for CO poisoning include installing CO detectors, regularly inspecting and maintaining heating systems, and not idling vehicles in enclosed spaces.</li>
</ul>

[1] Carbon monoxide poisoning. Harvard Health. March 22, 2023. Accessed November 15, 2023.

[2] Afolayan, J. M., Olajumoke, T., Amadasun, F., & Isesele, T. O. (2014). Knowledge and attitude of nigerian personnel working at federal medical centre in nigeria on carbon monoxide poisoning from electrical power generators. South African Family Practice, 56(3), 178-181.

[3] Carbon monoxide (CO) poisoning prevention. Centers for Disease Control and Prevention. January 9, 2023. Accessed November 15, 2023.

[4] Mattiuzzi C, Lippi G. Worldwide epidemiology of carbon monoxide poisoning. Hum Exp Toxicol. 2020;39(4):387-392. doi:10.1177/0960327119891214

[5] Wright J. Chronic and occult carbon monoxide poisoning: We don’t know what we’re missing. Emergency Medicine Journal. September 1, 2002. Accessed November 15, 2023.