Carbon Monoxide Poisoning

Daniel Mathieu1, Monique Mathieu-Nolf2, Jean-Christophe Linke1'2, Raphaël Favory1, Francis Wattel1

1Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier Régional Universitaire, Lille, France Centre AntiPoison, Centre Hospitalier Régional Universitaire, Lille, France

Abstract: Carbon monoxide (CO) poisoning still remains a serious public health problem in Europe. Beyond the well-known effects of CO on hemoglobin, the role of CO binding to other hemoproteins like myoglobin and cytochrome a-a3 has been identified more recently. Moreover, in addition to the hypoxic injury, the reoxygenation phase may itself induce toxic effects by mechanisms closely related to the ischemia-reperfusion phenomenon.

Clinical manifestations include neurological disturbances, cardiac arrhythmias, and respiratory and circulatory failure which usually ceases when the patient is removed from the toxic atmosphere and given oxygen. However, long term neurological manifestations may occur and lead to severe functional impairment and disabilities.

Oxygen is the basis of the treatment and Hyperbaric oxygen therapy (HBO) has been proven more effective in preventing cognitive sequelae than normobaric oxygen. HBO is recommended for all patients remaining comatose on hospital admission; those who have lost consciousness during toxic exposure; those with persisting neurological disorders. It is also indicated for pregnant women after exposure to CO. Well designed prevention programs are urgently needed in our countries to decrease the incidence and consequences of CO poisoning

Keywords: Carbon monoxide, poisoning (carbon monoxide), carboxyhemoglobin, myoglobin cytochrome a-a3, ischemia-reperfusion, re-oxygenation, apoptosis, neurologic sequelae (carbon monoxide)

Carbon monoxide (CO) poisoning is actually the primary cause of accidental poisoning in Europe1 and North America2. Despite efforts in prevention and public and medical education, this intoxication remains frequent, severe, and too often overlooked.

It occurs frequently: in France alone, carbon monoxide accounts for nearly 5000-8000 poisonings. This number is likely to increase because devices able to produce CO are used more and more by the general public. In addition, the energy crisis is leading people to decrease air ventilation in their homes even more. Thus, these two factors join together to increase the risk of CO production.

It is severe: Carbon monoxide is responsible for hundreds of deaths annually in Europe. Death is not the only adverse outcome, however. Many poisonings result in permanent neurological sequelae.

It is underdiagnosed and thus inadequately managed: A French Poison Control Center study3 showed that nearly 30 % of CO poisonings were overlooked or misdiagnosed during the first visit to the hospital or to a general practitioner.

Hyperbaric oxygen (HBO) therapy is actually well recognized as the treatment of choice, even if some controversy remains concerning the treatment of minor poisoning.

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