Carbon monoxide poisoning

Learning objectives

Carbon monoxide is a colorless, odorless, tasteless gas produced by burning gasoline, wood, propane, charcoal, or other fuel
volatile anesthetics can produce CO when used with CO2 absorbents
CO intoxication causes tissue hypoxia in three ways:
- CO binds with hemoglobin with about 250 times the affinity of oxygen, therefore, preventing oxygen binding
- CO also leads to a shift in the oxygen dissociation curve to the left impending delivery
- CO competitively inhibits the binding of oxygen with cytochrome oxidase, a key mitochondrial enzyme, significantly impairing cellular utilization of oxygen
Mortality is 1-3%

Acute poisoning
Central nervous system	Headache Dizziness Confusion Altered mental status Incoordination Ataxia Seizures Coma
Cardiovascular system	Dysrhythmias Ischemia Hypertension Hypotension
Gastrointestinal tract	Abdominal pain Nausea Vomitting Diarrhea
Respiratory system	Dyspnea Tachypnea Chest pain Palpitation
Other	Non-cardiogenic pulmonary edema Lactic acidosis Rhabdomyolysis Hyperglycemia Disseminated Intravascular Coagulation (DIC) Bullae Alopecia Sweat gland necrosis
Chronic exposure
May have similar effects to acute poisoning, but often with a gradual, insidious onset, and symptoms may fluctuate with varying levels of exposure to CO over time	Headache Personality changes Poor concentration Dementia Psychosis Parkinson’s disease Ataxia Peripheral neuropathy Hearing loss

Chronic fatigue
Permanent brain damage
Damage to your heart, possibly leading to life-threatening cardiac complications
Fetal death or miscarriage
Death