Treatment of Carbon Monoxide Poisoning

TABLE 14-5. DSM-IV-TR diagnoses attributed to carbon monoxide poisoning 

Substance-induced psychotic disorder Substance-induced anxiety disorder Substance-induced delirium Substance-induced persisting amnestic disorder Symptoms of dementia 

TABLE 14-6. Diagnostic tests for carbon monoxide poisoning 

Electrocardiogram (evidence of myocardial infarction or arrhythmias) Brain computed tomography or magnetic resonance imaging Electroencephalogram 

Medical treatment of acute and delayed symptoms consists of immediate 100% oxygen followed by hyperbaric oxygen (Myers et al. 1985). Rapid treatment with hyperbaric oxygen frequently prevents neuropsychiatric sequelae (Norkool and Kirkpatrick 1985). Psychiat- 

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Carbon monoxide (CO) is a colorless, odorless gas that is ubiquitous because it is created whenever carbon-containing materials are burned. Carbon monoxide poisoning is the leading cause of death due to poisoning in the USA. Most cases occur in victims of fires, but accidental and suicidal exposures are also common. The diagnosis and treatment of carbon monoxide poisoning are described in Chapter 56. Many other toxic gases are produced in fires or released in industrial accidents (Table 58-5). 

Hamilton-Farrel, M.R., Henry, J. (2000). Treatment of carbon monoxide poisoning in the United Kingdom. In Carbon Monoxide Toxicity (D.G. Penny, ed.), pp. 331-43. CRC Press, Washington, DC. 

Hardy, K.R., Thom, S.R. (1994). Pathophysiology and treatment of carbon monoxide poisoning. J. Toxicol. Clin. Toxicol. 32 613-29. 

Sluijter, M.E. (1967). The treatment of carbon monoxide poisoning by administration of oxyen a high atmospheric pressure. Prog. Brain Res. 24 123-82. 

Treatment of carbon monoxide poisoning consists of breathing a mixture of 95% O2 and 5% CO2, which will usually eliminate carbon monoxide from the body in 30-90 minutes, or of breathing hyperbaric oxygen. 

Smith, G., and Sharp, G. R., Treatment of carbon monoxide poisoning with oxygen under pressure. Lancet II, 905-906 (1960). 

Drugs are of little value in the treatment of carbon monoxide poisoning. Coffee may be given if the patient is able to hold a cup. Alcohol should not be given. 

Treatment of carbon monoxide poisoning is enhanced by adrranistration hyper-l ric oxygen. 

In the past, hyperbaric oxygenation as a medical procedure has received considerable attention. In this treatment the patient is given pure oxygen and may be placed in a pressurized chamber. In effect, the patient may thus receive >400 kPa (>4 atm) of pure oxygen. Beneficial results in cases of carbon monoxide poisoning, gangrene, severe bums, and other difficulties are often achieved as a result of this treatment. 

Occurrence. Carbon monoxide is a product of incomplete combustion and is not likely to result where a flame bums in an abundant air supply, yet may result when a flame touches a cooler surface than the ignition temperature of the gas. Gas or coal heaters in the home and gas space heaters in industry have been frequent sources of carbon monoxide poisoning when not provided with effective vents. Gas heaters, though properly adjusted when installed, may become hazardous sources of carbon monoxide if maintained improperly. Automobile exhaust gas is perhaps the most familiar source of carbon monoxide exposure. The manufacture and use of synthesis gas, calcium carbide manufacture, distillation of coal or wood, combustion operations, heat treatment of metals, fire fighting, mining, and cigarette smoking represent additional sources of carbon monoxide exposure (105—107). 

One treatment for carbon monoxide poisoning is administration of oxygen. The high concentration of oxygen binds to free hemoglobin, including the Hb from the equilibrium between Hb and CO. This is an application of ... 

Gas Chromatographic Determination of Carbon Monoxide in Blood and the Hyperbaric Oxygen Treatment in Carbon Monoxide Poisoning Cases J. Pharm. Belg. 25(3) 247-258 (1970) CA 74 30472a... 

Penney DG. Acute carbon monoxide poisoning animal model A review. Toxicology 1990 62 123. Penny DG. A review Hemodynamic response to carbon monoxide. Environ Health Perspect 1988 77 121. Rocco TP, Fang JC. Pharmacological treatment of heart failure. In Brunton L, Lazo J, Parker K, eds. 

Norkool, D.M., Kirkpatrick, J.N. (1985). Treatment of acute carbon monoxide poisoning with h q3erbaric oxygen a review of 115 cases. Ann. Emerg. Med. 14 1168-71. 

White, S.R., Penny, D.G. (1994). Effects of insulin and glucose treatment on neurologic outcome after carbon monoxide poisoning. Ann. Emerg. Med. 23 606 (Abst.). 

Burney RE, Wu S, and Nemiroff MJ (1982) Mass carbon monoxide poisoning Clinical effects and results of treatment in 184 victims. Annals of Emergency Medicine 11 394-399. 

In addition to antidotal therapy, administration of 100% oxygen can help with cyanide detoxification, possibly by affecting the binding of cyanide to cytochrome oxidase (13). Hyperbaric therapy may be considered, but only after standard treatment has failed, or if the patient has concurrent carbon monoxide poisoning (13). 

Mathieu D> Nolf M, Durocher A, Saulnier F, Frimat P, Furon D, et al. Acute carbon monoxide poisoning Risk of late sequelae and treatment by hyperbaric oxygen. Clin Toxicol 1985 23 315-24. 

Myers RAM, Britten JS. Are arterial blood gases of value in treatment decisions for carbon monoxide poisoning Grit Care Med 1989 17 139-42. 

L9. Lawson, D. D., McAllister, R. A., and Smith, G., Treatment of acute experimental carbon-monoxide poisoning with oxygen imder pressure. Lancet I, 800-802 (1961). 

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