Carbon monoxide poisoning: an ancient and frequent cause of accidental death

Dubrey, Simon W; Chehab, Omar; Ghonim, Sarah

doi:10.12968/hmed.2015.76.3.159

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…Previous studies have shown that DNS can develop in up to 45% of patients after acute CO poisoning. 13,26,27 Thus, special attention should be paid to patients with acute CO poisoning, even when they do not show neurological deficits at the time of presentation or discharge. Although this high rate has necessitated that screening be used for patients with a high risk of DNS, previous studies have failed to define meaningful screening measures for assessing the probability of DNS.…”

Section: Discussionmentioning

confidence: 99%

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Acute Brain Lesions on Magnetic Resonance Imaging and Delayed Neurological Sequelae in Carbon Monoxide Poisoning

et al. 2018

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Preventing delayed neurological sequelae is a major goal of treating acute carbon monoxide poisoning, but to our knowledge there are no reliable tools for assessing the probability of these sequelae. OBJECTIVES To determine whether acute brain lesions on diffusion-weighted imaging are related to subsequent development of delayed neurological sequelae after acute carbon monoxide poisoning. DESIGN, SETTING, AND PARTICIPANTS This registry-based observational study was conducted at a university hospital in Seoul, Korea, between April 1, 2011, and December 31, 2015. Of 700 patients (aged Ն18 years) with acute carbon monoxide poisoning, 433 patients (61.9%) who underwent diffusion-weighted imaging at an emergency department were considered for the study. Patients who developed cardiac arrest before diffusion-weighted imaging (n = 3), had persistent neurological symptoms at discharge (n = 8), committed suicide soon after discharge (n = 1), and were lost to follow-up (n = 34) were excluded. EXPOSURE The presence of unambiguous, high-signal-intensity, acute brain lesions on diffusion-weighted imaging (b = 1000 s/mm 2). MAIN OUTCOMES AND MEASURES Development of delayed neurological sequelae defined as any neurological symptoms or signs that newly developed within 6 weeks of discharge. RESULTS Of the 387 included patients (143 women [37.0%]; median age, 42.0 years [interquartile range, 32.0-56.0 years]), acute brain lesions on diffusion-weighted imaging were observed in 104 patients (26.9%). Among these, 77 patients (19.9%) had globus pallidus lesions, 13 (3.4%) had diffuse lesions, and 57 (14.7%) had focal lesions (37 patients [9.6%] had >1 pattern concurrently). Lesions were supratentorial and infratentorial in 101 and 23 patients, respectively. Delayed neurological sequelae occurred in 101 patients (26.1%). Multivariable logistic regression analysis indicated that the presence of acute brain lesions was independently associated with development of delayed neurological sequelae (adjusted odds ratio, 13.93; 95% CI, 7.16-27.11; P < .001). The sensitivity and specificity of acute brain lesions to assess the probability of delayed neurological sequelae were 75.2% (95% CI, 66.8%-83.7%) and 90.2% (95% CI, 86.8%-93.7%), respectively. In addition, the positive and negative predictive values were 73.1% (95% CI, 64.6%-81.6%) and 91.2% (95% CI, 87.9%-94.5%), respectively. CONCLUSIONS AND RELEVANCE The presence of acute brain lesions was significantly associated with the development of delayed neurological sequelae. Diffusion-weighted imaging during the acute phase of carbon monoxide poisoning may therefore help identify patients at risk of developing these debilitating sequelae.

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Section: Discussionmentioning

confidence: 99%

“…The results of our study may have important clinical implications. Previous studies have shown that DNS can develop in up to 45% of patients after acute CO poisoning . Thus, special attention should be paid to patients with acute CO poisoning, even when they do not show neurological deficits at the time of presentation or discharge.…”

Section: Discussionmentioning

confidence: 99%

Acute Brain Lesions on Magnetic Resonance Imaging and Delayed Neurological Sequelae in Carbon Monoxide Poisoning

et al. 2018

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“…As most CO remains in the blood, the COHb percentage saturation (%COHb) acts as an estimate and a guide to help determine exposure levels . The symptoms of poisoning depend on the concentration of CO in the environment, the duration of exposure, the extent of any ventilation, and the presence of preexisting health conditions . Table shows how CO poisoning symptoms vary with %COHb ; however, the %COHb recorded in fatalities can vary greatly due to the specific circumstances of death .…”

Section: Effects Of Co In Humans According To %Cohbmentioning

confidence: 99%

Epidemiological Study of Carbon Monoxide Deaths in Scotland 2007–2016,

Lisbona

Hamnett

2018

Journal of Forensic Sciences

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Carbon monoxide (CO) intoxications are quite frequent in forensic toxicology. Using a sample of 209 CO-positive deaths in Scotland from 2007 to 2016, this study provides ranges of percentage CO saturations (%COHb) according to the CO source and examines any correlation with age, gender, alcohol, and preexisting disease. It also reports the full toxicological findings, including drug concentrations, in CO-positive cases. The highest numbers of fatalities involved males, occurred during autumn/winter, and the main source of CO was fire. The median %COHb in fire-related cases was significantly lower than in non-fire-related cases such as those involving exhausts, generators and gas supply systems, and portable BBQs. There was no relationship between %COHb and age, blood alcohol concentration, or the presence of preexisting cardiovascular and/or respiratory disease. Toxicology results revealed that prescription medications were the most commonly detected drug group and that the number of cases positive for controlled drugs was small.

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“…It binds to hemoglobin with an affinity 200 times greater than that of oxygen. A decrease in the oxygen transport capacity of hemoglobin results in hypoxia in tissue and vital organs such as the brain and heart (2). However, tissue hypoxia alone does not explain the toxic effects that result.…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of Protein Carbonyl Levels in Acute Carbon Monoxide Intoxication

Günaydın

Turkmen²,

Karaca³

et al. 2017

Konuralp Tıp Dergisi

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Objective: Carbon monoxide (CO) is the main cause of intoxication-related mortality and morbidity in developed countries. It is responsible for more than half of fatal intoxications in many countries. The purpose of this study was to determine the diagnostic value of protein carbonyl (PC), a good marker of oxidative stress, in association with oxidative stress resulting from hypoxia emerging in patients with acute CO intoxication. Methods: Thirty-four patients diagnosed with acute CO intoxication at the Emergency Department and 38 healthy volunteers were included in the study. Patients' PC levels at time of admission and after treatment were compared with those of a control group. Results: No statistically significant difference was observed among PC levels at time of admission in the patient and control groups (p =0.305, patient group 0.025 ± 0.01, control group 0.026 ± 0.01). A significant decrease was determined in post-treatment PC levels in the patient group compared to those at time of admission (p = 0.006, admission 0.025 ± 0.01, post-treatment 0.017 ± 0.008). No significant correlation was determined between patients' carboxyhemoglobin (CO-Hb) levels and PC levels at time of admission (Correlation coefficient =-0.006, p= 0.971). Conclusions: We think that PC is not suitable for use as a biomarker in the acute period in patients with CO intoxication.

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Carbon monoxide poisoning: an ancient and frequent cause of accidental death

Abstract: Carbon monoxide poisoning is both an ancient and current cause of inadvertent (accidental) death and more recently has emerged as a cause of suicide worldwide. This article describes the pathophysiology and epidemiology of this most toxic and frequently occult poison.

Cited by 10 publications

References 26 publications

Acute Brain Lesions on Magnetic Resonance Imaging and Delayed Neurological Sequelae in Carbon Monoxide Poisoning

Acute Brain Lesions on Magnetic Resonance Imaging and Delayed Neurological Sequelae in Carbon Monoxide Poisoning

Epidemiological Study of Carbon Monoxide Deaths in Scotland 2007–2016,

The Diagnostic Value of Protein Carbonyl Levels in Acute Carbon Monoxide Intoxication

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