Lack of the correlation between biochemical effects on rats and blood carboxyhemoglobin concentrations in various conditions of single acute exposure to carbon monoxide

Inhibition of hypoxic pulmonary vasoconstriction of rats by carbon monoxide

Hypoxic pulmonary vasoconstriction (HPV), a unique response of pulmonary circulation, is critical to prevent hypoxemia under local hypoventilation. Hypoxic inhibition of K(+) channel is known as an important O(2)-sensing mechanism in HPV. Carbon monoxide (CO) is suggested as a positive regulator of Ca(2+)-activated K(+) channel (BK(Ca)), a stimulator of guanylate cyclase, and an O(2)-mimetic agent in heme moiety-dependent O(2) sensing mechanisms. Here we compared the effects of CO on the HPV (P(O(2)), 3%) in isolated pulmonary artery (HPV(PA)) and in blood-perfused/ventilated lungs (HPV(lung)) of rats. A pretreatment with CO (3%) abolished the HPV(PA) in a reversible manner. The inhibition of HPV(PA) was completely reversed by 1H-[1,2,4]oxadiazolo-[4,3-a]quinoxalin-1-one (ODQ), a guanylate cyclase inhibitor. In contrast, the HPV(lung) was only partly decreased by CO. Moreover, the partial inhibition of HPV(lung) by CO was affected neither by the pretreatment with ODQ nor by NO synthase inhibitor (L-NAME). The CO-induced inhibitions of HPV(PA) and HPV(lung) were commonly unaffected by tetraethylammonium (TEA, 2 mM), a blocker of BK(Ca). As a whole, CO inhibits HPV(PA) via activating guanylate cyclase. The inconsistent effects of ODQ on HPV(PA) and HPV(lung) suggest that ODQ may lose its sGC inhibitory action when applied to the blood-containing perfusate.

Paradoxical rescue from ischemic lung injury by inhaled carbon monoxide driven by derepression of fibrinolysis

Carbon monoxide (CO) can arrest cellular respiration, but paradoxically, it is synthesized endogenously by heme oxygenase type 1 (Ho-1) in response to ischemic stress. Ho-1-deficient (Hmox1-/-) mice exhibited lethal ischemic lung injury, but were rescued from death by inhaled CO. CO drove ischemic protection by activating soluble guanylate cyclase and thereby suppressed hypoxic induction of the gene encoding plasminogen activator inhibitor-1 (PAI-1) in mononuclear phagocytes, which reduced accrual of microvascular fibrin. CO-mediated ischemic protection observed in wild-type mice was lost in mice null for the gene encoding PAI-1 (Serpine1). These data establish a fundamental link between CO and prevention of ischemic injury based on the ability of CO to derepress the fibrinolytic axis. These data also point to a potential therapeutic use for inhaled CO.

A positron emission tomography study of patients with acute carbon monoxide poisoning treated by hyperbaric oxygen

Seven patients with an acute and severe carbon monoxide intoxication were treated with hyperbaric oxygen and underwent a positron emission tomographic examination 2-5 days after the acute event. Although the final clinical outcome was good in all patients, ischaemic changes were observed. Three patients with temporary sequelae after hyperbaric oxygen treatment showed the most severe changes, mainly in striatum and thalamus. Although positron emission tomographic examination cannot predict the final outcome, it can show the regions at risk for development of late complications following carbon monoxide poisoning.

Dibromomethane and carbon monoxide in the rat: comparison of the cardiovascular and metabolic effects

The goals of this study were to examine the cardiovascular and metabolic responses to a dihalogenated methane and to compare them to inhaled CO. One group of male Sprague-Dawley rats received an i.p. injection of either 3 or 6 mmol kg-1 dibromomethane (DBM) diluted 1:3 with sesame oil. Measurements of carboxyhemoglobin (COHb), rectal body temperature (BT), heart rate, systolic blood pressure (BP) and blood glucose and lactate concentrations were made at times 0, 30, 60, 120, 240, 360, 480, 600, 720, 840, 1020, 1440 and 1680 min. A second group of rats received only sesame oil and was tested in the same manner. A third group of rats breathed 225 ppm CO for 120 min before being tested. Peak COHb levels were 16% 8 h after 3 mmol kg-1 DBM, 18% 12 h after 6 mmol kg-1 DBM and 17% in the CO-exposed group. The sesame oil controls exhibited no elevation in COHb. The BT dropped by ca. 1 degree C in both the DBM- and CO-exposed rats, while there was no BT change in the sesame oil controls. The BT dropped by 1.0 degree C and 1.2 degree C after 6 h in the 3 and 6 mmol kg-1 DBM groups, respectively, and by 0.9 degree C after 120 min in the CO-exposed group. The CO-exposed rats displayed a 12 mmHg decrease in systolic BP, while both doses of DBM failed to produce any significant BP change. The BP in the sesame oil controls remained constant.(ABSTRACT TRUNCATED AT 250 WORDS)

Magnetic resonance imaging of the rat brain following acute carbon monoxide poisoning

Magnetic resonance (MR) may be used for repeatedly and non-invasively imaging the brain. Until now, no studies have used this approach to study the effects of carbon monoxide (CO) poisoning in a defined animal model. Conscious, Levine-prepared female rats (unilateral carotid artery and jugular vein occlusion) were exposed to 2400 ppm CO for 90 min, with or without the infusion of 50% glucose solution; CO-stimulated increases in blood glucose and lactate occurred in both groups, while blood pressure and body temperature fell. One to four hours following termination of CO exposure, increased cortical pixel intensity, cortical surface area and brain midline shift were observed on the operated side of the brain in some rats of both groups (i.e. responders = R), providing evidence of edema. At sacrifice, 5 h following termination of CO exposure, gross water content was increased on the left side in the corresponding cortical slices in R rats, providing another measure of edema. Significant positive correlations were found between left to right pixel intensity difference and water content difference, and between the extent of midline shift and water content difference. The elevations of blood glucose and lactate concentrations, and the magnitudes of CO-induced hypothermia and hypotension were similar to those in past studies, but appeared to exert no effect on the severity of cortical edema in terms of differences in pixel intensity, surface area, midline shift or gross tissue water content. Thus, the observed differences between the R rats is not explained by the available data.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular, metabolic and neurologic effects of carbon monoxide and cyanide in the rat

Levine-prepared, female Sprague-Dawley rats were used to investigate the effects of carbon monoxide (CO) and cyanide (CN) on heart rate, blood pressure, hematocrit, body temperature, blood glucose, lactate, and neurologic function. Rats were exposed to either 2400 ppm CO, 1500 ppm CO, 4 mg/kg NaCN, or both 1500 ppm CO and 4 mg/kg NaCN for 90 min, followed by 4 h of room air recovery. Following exposure to 2400 ppm CO, rats exhibited a significant bradycardia which normalized by 2 h of recovery. All groups exhibited an initial hypotension which was either maintained or exaggerated during exposure in all but the rats exposed to CN, and which returned to pre-exposure values by 90 min. All groups experienced a significant hypothermia during the exposure period, with those in the 1500 ppm CO or the CN returning to initial values over the recovery period. The only significant change in hematocrit was due to 2400 ppm CO (4.1% increase). During exposure, all groups experienced an initial surge in glucose concentration which was maintained in all but rats exposed to 2400 ppm CO. The greatest hyperglycemic response resulted from the combination of CO and CN, whereas 2400 ppm CO produced the smallest. CN alone produced no significant rise in lactate concentration. However, lactate concentration in all other groups was significantly elevated during the exposure period, returning to initial values by 4 h of recovery. Lactate concentrations and neurologic deficit in rats exposed to 1500 ppm CO, when added to those rats treated with CN, closely approximated the lactate and neurologic deficit of the combination treatment. Neurologic deficit was greatest in rats exposed to 2400 ppm CO. While in most cases the responses of the rats to CO and CN differed whether the substances were administered alone or in combination, a synergistic relationship is not suggested. An additive or less than additive relationship is more likely.

Comparison of carbon monoxide and nitrogen induced effects on synaptic transmission in the rat hippocampal slice

A comparison has been made of the effects of carbon monoxide (CO) or nitrogen (N2) exposure on synaptic transmission in the hippocampal slice. CA1 field potentials, evoked by Schaffer collateral stimulation, were unaffected by superfusion of slices with artificial cerebral spinal fluid (ACSF) equilibrated with either 15% CO or 15% N2 for 120 min. However, superfusion with hypoxic ACSF equilibrated with either 85% CO or 85% N2 caused a rapid depression of synaptic transmission. Reperfusion with control ACSF following 30 min hypoxia led to recovery of evoked responses and a slight hyperexcitability. In the hippocampal slice, synaptic transmission, as assessed by input/output curves, was not different during or following hypoxia induced by exposure to CO or N2. In the short term, CO is not toxic.

Blood lactate and catecholamine levels in the carbon monoxide-exposed rat: the response to elevated glucose

Previous studies have shown that elevated blood glucose is detrimental to the outcome in acute carbon monoxide (CO) poisoning. The present goals were to characterize the blood lactate and catecholamine changes and to determine whether elevated blood glucose results in increases in the levels of these substances. Two groups of adult Sprague-Dawley, Levine-prepared, female rats (n = 22 each) were exposed to 2400 ppm CO for 90 min: one group received nothing (CO alone), while the other group was infused with a 50% glucose solution (4 ml/kg) (CO + glucose). The usual hypothermia, hypotension, bradycardia and hemoconcentration associated with acute severe CO poisoning were observed. Survival rates were 68% and 54% in the CO alone and CO + glucose groups, respectively. Arterial blood pressure tended to decline more in rats that died; the difference was significant in the CO + glucose group. In the CO alone group, plasma glucose concentration was significantly lower after CO exposure in rats that died than in survivors (35 +/- 15 vs. 99 +/- 16 mg/dl). In the CO + glucose group, glucose concentration was significantly higher after 45 min in rats that died (d) than in survivors (s) (447 +/- 29 vs. 324 +/- 31 mg/dl). Elevated blood glucose in the CO + glucose group failed to significantly increase blood lactate; however, lactate tended to be higher in rats that died in both groups [CO alone group: 175 +/- 17 (d) vs. 138 +/- 9 (s); CO + glucose group: 154 +/- 10 (d) vs. 143 +/- 8 (s)]. Plasma epinephrine and norepinephrine increased significantly 6-10-fold and 2-6-fold in each of the two groups, respectively; however, catecholamine levels were not related to either the administration of glucose or survival. With regard to CO poisoning in this animal model, the results do not support the hypotheses that elevated blood glucose exacerbates the increase in blood lactate, that increased catecholamine increases glucose, or that greater CO-induced hypoglycemia results from increased lactate production. The results do show that death is related to abnormally high or low blood glucose, but that it is not due to higher blood lactate or catecholamine levels.

Effect of ethanol on fatal carbon monoxide poisoning in awake mice [correction of rats]

The effect of ethanol on fatal carbon monoxide (CO) poisoning was investigated in mice injected intraperitoneally with ethanol. Ethanol (1.5 and 3.0 g/kg) was injected 15 min prior to exposure to gas containing 6.6% CO. The survival period was significantly lengthened with ethanol in proportion to the doses injected, although the carboxyhemoglobin (CO-Hb) saturation level in postmortem blood was almost the same in all groups. On the other hand, the CO-Hb level in the blood of mice injected with ethanol was significantly lower than that of control mice during the early exposure period when all mice were still alive. Our results showed that the acute ethanol injection did not influence the CO-Hb saturation level in blood at death, but did affect the duration of survival, probably because of ethanol's ability to decrease blood flow and CO intake.

The effect of exposure duration on the blood level of glucose, pyruvate and lactate in acute carbon monoxide intoxication in man

Blood glucose, pyruvate and lactate were examined during hospitalization of 13 cases of acute carbon monoxide poisoning developing from short (less than or equal to 1.5 h) or long (10-14 h) exposure. CO intoxication resulted in increased blood levels of all carbohydrate metabolites studied. Increased levels of pyruvate and lactate were much more pronounced and lasted for a longer time following long, compared with short, CO exposure despite similar blood COHb level (about 40% at the beginning of hospitalization). The results showed difference in biochemical effect of short and long single exposure to CO that could not be detected by the measurement of COHb.

The relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man

The relationship between exposure duration, COHb, blood glucose, pyruvate and lactate and the severity of intoxication was investigated in a group of 39 cases of acute CO poisoning treated in the Clinical Toxicology Center in Lódź, Poland. On the basis of clinical criteria the patients were classified into cases of mild, moderate, severe and very severe CO poisoning. COHb and carbohydrate metabolites were estimated in venous blood taken immediately after admission of the patient to hospital prior to treatment. The severity of intoxication did not correlate with blood COHb; variation in exposure duration seems to be responsible for this phenomenon. Severe and very severe poisonings were associated with longer exposures and were accompanied by a markedly higher blood lactate level, compared to mild and moderate cases. Blood pyruvate depended less than lactate on the severity of intoxication. Blood glucose depended neither on exposure duration nor on the severity of intoxication. Among the carbohydrate metabolic parameters studied, blood lactate determination can be helpful in the evaluation of the severity of CO poisoning in man.

Two cases of acute carbon monoxide poisoning with delayed neurological sequelae after a "free" interval

Two cases are presented to illustrate the delayed neurological complications which may follow carbon monoxide (CO) poisoning, the mechanisms of which are not well known and which do not seem to be recognized widely enough to safeguard patients. Broad discussion is needed to determine how cases of CO exposure/poisoning should best be handled if sequelae are to be avoided.

The content of carbon monoxide in the tissues of rats intoxicated with carbon monoxide in various conditions of acute exposure

Tissue carbon monoxide (CO) content was investigated in rats severely intoxicated with CO under various exposure conditions: 1% CO for 4 min, 0.4% CO for 40 min and 0.12% CO for 12 h. Extravascular CO was determined in the heart and skeletal muscles immediately after termination of exposure, and carboxymyoglobin (MbCO) percent saturation was calculated. Total brain CO was estimated immediately after termination of exposure and after the time periods of restitution. After the same exposure conditions, MbCO percent saturation was higher in the heart than in skeletal muscle. In both types of muscle, saturation of myoglobin (Mb) with CO depended on blood carboxyhemoglobin (HbCO) level and not on the duration of exposure. The time course of CO elimination was the same for blood and brain, irrespective of CO exposure conditions. The results obtained showed that acute CO intoxication induced by long duration exposures did not involve CO accumulation in the tissues.

Effect of different conditions of acute exposure to carbon monoxide on the cerebral high-energy phosphates and ultrastructure of brain mitochondria in rats

Rats were exposed to carbon monoxide (CO) in different conditions: 4 min at 1.3% CO, 40 min at 0.5% CO or 12 h at 0.13--0.15% CO. After 4 min exposure to 1.3% CO the brain content of ATP and PC was substantially reduced; after 40 min exposure to 0.5% CO the cerebral ATP level was slightly increased, whereas the content of both ATP and PC in the brain of rats exposed to CO for 12 h was significantly higher than in the controls. The decrease in the brain level of ATP and PC after 4 min exposure to 1.3% CO was accompanied by ultrastructural changes of mitochondria. No evident differences in the level of cerebral high-energy phosphates were found between rats intoxicated with CO and rats subjected to experimental hypoxemia.

Hyperuricemia in rats during acute carbon monoxide poisoning

The effect of carbon monoxide (CO) inhalation on plasma levels of uric acid and hypoxanthine in rats was investigated. Exposure to 3% CO caused respiratory arrest within about 2 minutes. The plasma uric acid level of CO-treated rats increased to 157% above that of ether-treated rats. When rats were exposed to 1% or 0.8% CO, the exposure periods until the onset of respiratory arrest were prolonged, and plasma uric acid levels at respiratory arrest were further elevated. Plasma uric acid levels at respiratory arrest increased with prolongation of the exposure periods. Under our experimental conditions, hypoxanthine or xanthine was not detected in plasma of CO-treated rats. These results are discussed in relation to the hyperuricemia in hemorrhagic shock or hypoxemia: CO-induced hyperuricemia can be attributed to the stimulated degradation of adenine nucleotides under tissue anoxia, and thus could be an excellent parameter of tissue anoxia.