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Carbon monoxide poisoning
Carbon monoxide is a byproduct of combustion that can be emitted from gasoline engines, heating systems, and other fuels when burned. It binds to hemoglobin in red blood cells, preventing oxygen from binding and being transported through the body. Symptoms of carbon monoxide poisoning range from mild headaches and nausea at lower levels to confusion, loss of consciousness, and even death at higher levels. Treatment involves removing the victim from the source of carbon monoxide and providing 100% oxygen therapy to allow the carbon monoxide to clear from the body.
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Carbon monoxide poisoning
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- 2. What IS CarbonMonoxide? It is a byproduct of combustion reactions, or the burning of certain fuels. CO can be emitted from gasoline-powered engines, natural gas heating systems, oil, coal, propane, wood and other materials which may also release carbon monoxide when burned.
- 4. Half-life of CarbonMonoxide Half-life – time required for half the quantity of a drug or other substance to be metabolized or eliminated CO half-life on 21% room air O2 – 4 - 6 hours CO half-life on 100% O2 – 80 minutes CO half-life with hyperbaric O2 – 22 minutes
- 5. Expected Carboxyhemoglobin Levels Non-smokers – 5% Smokers – up to 10% 5 – 6% for a 1 pack per day smoker 7 - 9% for a 2-3 pack per day smoker Up to 20% reported for cigar smokers Urban commuter – 5%
- 6. Carbon Monoxide Absorption Minute ventilation • Amount of air exchanged in the lungs within one minute Duration of exposure • The longer the exposure, the more the absorption Concentration of CO in the environment • The higher the concentration, the greater the toxicity Concentration of O2 in the environment • The lower the O2 concentration to begin with, the faster the symptoms will develop o higher altitudes o closed spaces
- 7. Increased Risks Infants Women whoare pregnant Fetus at greatest risk because fetal hemoglobin has a greater affinity for oxygen and CO compared to adult hemoglobin Elderly Physical conditions that limit the body’s ability to use oxygen Emphysema, asthma Heart disease Physical conditions with decreased O2 carrying capacity Anemia – iron-deficiency & sickle cell
- 8. Toxicokinetics Lungs absorbCO combines with Hb(85%) + myoglobin (15%) eliminated through lungs
- 9. Effects of CarbonMonoxide CO binds more readily to hemoglobin (Hgb) displacing oxygen and forming carboxyhemoglobin Premature release of O2 prior to reaching distal tissue leads to hypoxia at the cellular level Inflammatory response is initiated due to poor and inadequate tissue perfusion Myocardial depression from CO exposure Dysrhythmias, myocardial ischemia, MI Vasodilation – from increased release of nitric oxide; worsening tissue perfusion and leading to syncope
- 10. Clinical Features AcutePoisoning Early: Non-specific 2 classical features (rare): Cherry red colour – blood + tissues Cutaneous bullae/blisters Based on severity: Mild (COHb <30%) Moderate (30-40%) Severe (>40%)
- 12. Acute Poisoning MildSeverity Headache Nausea Vomiting Dizziness Exertional Dyspnea
- 13. Acute Poisoning Moderate Chest pain Blurred vision Confusion Weakness Increasing dyspnea Tachycardia Tachypnea Ataxia
- 14. Acute Poisoning Severe Trismus Muscle Spasms Convulsions Palpitations Disorientation Vent arrhythmias Hypotension MI Respiratory failure Coma
- 15. Chronic Poisoning Headache,dizziness, confusion Weakness, nausea, vomiting, abdominal pain Paraesthesia Visual disturbances Hypertension Hyperthermia Cherry red skin Palpitations Aggravation of Angina
- 16. CO Levels withRelated Signs and Symptoms >5% - mild headache 6-10% - mild headache, SOB with exertion 11-20% - moderate headache, SOB 21-30% - worsening headache, nausea, dizziness, fatigue 31-40% - severe headache, vomiting, vertigo, altered judgment 41-50% - confusion, syncope, tachycardia 51 – 60% - seizures, shock, apnea, coma
- 17. Carboxyhemoglobin levels of<15 – 20% Mild severity Headache – mild to moderate Shortness of breath Nausea and vomiting Dizziness Blurred vision
- 18. Carboxyhemoglobin levels of21 – 40% Moderate severity Worsening headache Confusion Syncope Chest pain Dyspnea Tachycardia Tachypnea Weakness
- 19. Carboxyhemoglobin levels of41 - 59% Severe Dysrhythmias, palpitations Hypotension Cardiac ischemia Confusion Respiratory arrest Pulmonary edema Seizures Coma
- 20. Carboxyhemoglobin levels of>60% Fatal Death
- 21. Diagnosis Estimation ofCOHb level Pulse oximetry Arterial blood gases ECG Chest X-ray Bedside tests
- 22. DDX Alcoholic intoxication Hyperventilation syndrome Cerebrovascular accident Meningitis/encephalitis Migraine Epilepsy Food poisoning
- 23. Treatment Immediate removalfrom contaminated environment 100% O2 – endotracheal tube Monitor C&D Neurologic exam + CAT scan + fundoscopic exam If ICT increased Hyperventilation Head elevation Mannitol
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