carbon monoxide poisoning

1. Carbon monoxide
and other
poisonings
Dr kishore kumar
Dept of General Medicine

2.  Carbon monoxide:
 Carbon monoxide (CO) is one of the most
common and widely distributed air pollutants.
 It is a colourless, odourless and tasteless gas
that is poorly soluble in water
 Concentration of CO -0.05– 0.12 ppm
 Produced by nob biological and biological
elements

3. Sources:
 60% are from human activities and about 40%
from natural processes
 Largest proportion of these emissions are
produced as exhausts of internal combustion
engines, especially by motor vehicles with
petrol engines.Other common sources include
various industrial processes, power plants
using coal, and waste incinerators.
 Natural nonbiological and biological sources,
such as plants, oceans and oxidation of
hydrocarbons.
 It reacts readily with haemoglobin to form

4. Routes of exposure
• Lungs are practically the only significant route
for environmental exposures. Dermal and
gastrointestinal absorptions are expected to be
negligible
• CO binds readily with haemoglobin to form
carboxyhaemoglobin (COHb) which can be
measured in a blood sample by specific
spectrophotometric or gas chromatographic
methods. As a biomarker COHb is specific and
closely related to the mechanisms of toxicity.
• Population groups with relatively high
exposures car, bus and taxi drivers, policemen,
traffic wardens, and garage and tunnel
workers. In addition, workers in metal

5. Pharmacokinetics:
• After reaching the lungs, CO diffuses rapidly
across the alveolar and capillary membranes.
• It also readily crosses the placental membranes.
• Carbon monoxide binds reversibly to one of the
haem proteins form COHb , causes a reduction in
the oxygen-carrying capacity of the blood.ODC-
oxyhemoglobin dissociation curve displaced to
Left.
• The affinity of haemoglobin for carbon monoxide is
200–250 times that for oxygen,
• Carbon monoxide is eliminated unchanged via the
lungs.

6. Clinical features :
 The organs most commonly effected are
brain,heart,muscles,fetus
 Brain:
headache,dizziness,nausea,vomiting,confusion
,vertigo,syncope,convulsions,coma,death.
 Heart:Tachycadia,hypotension
,palpitations,chest pain,arrythmias ,aggrevation
of Angina,decreased exercise
tolerance,shortness of breath,pulmonary
edema.

7.  Psychomotor effects, such as reduced
coordination, tracking and driving
ability,imoaired judgement, memory loss,
• Others muscle weakness,rhabdomyolysis
may cause myoglobinuria and renal
failure,urinary or faecal incontinence, and
gait distrubances,cherry red spots,,
• Maternal –hyperventilation,intra
uterine,perinatal deaths.

8. Management :
 Blood levels of CoHb:
20% means significant exposure ,40-5-% tells
intoxication
Do not correlate well with the severity of
poisoning,
 Ecg
 Acid base analysis-Metabolic acidosis suggests
severity
 Others-Electrolytes ,BUN,Creatinine..xray
chest,cardiac biomarkers,,
• ABC
• Oxygen should be high conc,given with tight fitting
mask or high flow oxygen with resorvoir, reduces
the half-life of carboxyhaemoglobin .
• Headache due to raised ICT –Mannitol,steroiuds,,

9. • Aluminium and zinc phosphide:
• Used as rodenticides and highly toxic fumigant
used for grain storage to kill rodents,insects..
• Extremely fatal ,common suicidal agent in
north,Available as tablets,powder..
• Aluminium phosphide ingestion more toxic than
zinc phosphide.
• With moisture Forms phosphine which is
pulmonary& Git toxicant.Causes inhibition of Cyt-C
oxidase,free radical inj leads to cellular hypoxia.

10. Clinical features:
• Garlic odour from
mouth,nausea,vomoting,diarrhea,chest
tightness,cough and breathlessness
progressing to ARDS and respiratory failure,
• Tremor, paraesthesiae, convulsions, coma.
• Tachycardia,arrythmias,myocarditis,cardioge
nic shock
• Metabolic acidosis, electrolyte disturbances,
hypoglycaemia,liver and renal failure, and
leucopenia and low Mg levels..

11. Detected by Silver nitrate test/strips detects
phosphine in exhaled air or stomach aspirates
and Gas chromatography.
• Treatment :
 ABC,
 Gastric lavage with charcol ,coconut oil
 Correction of acidosis,arrythmias
 Correction of hypotension,electrolytes
 and ventilatory support
 Antioxidants like NAC,vit-c ,beta carotene,
 Mgso4 as antiarrythmic and anti oxidants

12.  Copper sulphate:
 synonyms-blue stone,blue vitriol
 used as a fungicide,herbicide,algaecide,textile
dying,therapeutically antihelminthic in
veterinary.
 Toxicity include nausea, vomiting, abdominal
pain, diarrhoea,hematemesis,gastric
ulceration,discoloured (blue/green)
secretions,hypersalivation,
 Renal or liver failure,haemolysis,
rhabdomyolysis,convulsions and coma.
 Hemolytic anemia

13. • Treatment:
• Corrosive poisoning avoid gastric lavage
• Egg albimin
• PPI , H2 blockers
• DMPS (Dimercaptopropanesulfonate)
• D-pencillamine 250mg qid upto 2gms/day
• Inj.vitamin c
• Forced alkaline diuresis
• Supportive rx

14. LSD-Lysergic acid diethylamide:
 Is psychedelic drug-potent mood changing,Hallucinogen
 Lysergic acid derived from ergot fungus (Claviceps
purpura)which grows on rye and Morning glory seeds.
 Abused drug at clubs,raves
 Synonims Blue caps,acid,beast
 Mimic serotonin
 Produced in crystal form,transported as
liquid,odourless,colourless,slight bitter taste
 Anxiety,tingling feeling,nausea,
 Hallucinations mainly visual vivid colours then
auditory,dilated
pupils,hypertyension,hyperthermia.tachycardia,profuse
sweating,
 Good and bad trips
 Tremors,numbness,weakness ,dry mouth
 Guiddiness to extreme insight ,paranoid