Carbon monoxide poisoning. An occult epidemic

Carbon Monoxide Poisoning was Associated With Lifetime Suicidal Ideation: Evidence From A Population-Based Cross-Sectional Study in Hebei Province, China

Objectives: We want to test the association between carbon monoxide poisoning (CMP) experiencing and lifetime suicidal ideation/suicide plan among community residents.

Methods: This is a population-based cross-sectional study conducted among community residents in Hebei province, China. We analyzed a total of 21,376 valid questionnaires. CMP experience and lifetime suicidal ideation/suicide plan were assessed in this study. Logistic regression and false discovery rate correction were conducted to analyze the associations and correct the p values.

Results: We found that CMP (OR = 2.56, p < 0.001, corrected-p = 0.001) was associated with lifetime suicidal ideation, and the other risk factors were female (OR = 0.53, p < 0.001, corrected-p = 0.001). The association between CMP and suicide plan was not supported after false discovery rate correction (OR = 2.15, p = 0.035, corrected-p = 0.385). For the CMP patients, experiencing ≥2 times CMP (OR = 2.76, p = 0.001, corrected-p = 0.011) was also in higher risk of lifetime suicidal ideation. The association between CMP times and lifetime suicidal plan was not supported after false discovery rate correction (OR = 4.95, p = 0.021, corrected-p = 0.231).

Conclusion: CMP patients are in higher risk of lifetime suicidal ideation. For CMP patients, some strategies are needed to control their suicidal ideation.

Chronic carbon monoxide poisoning. A report of two cases

If acute carbon monoxide poisoning is a well-known emergency situation, this is not the case for chronic poisoning. The missed diagnosis of acute CO poisoning is a well-known problem but the identification of a chronic poisoning is very challenging. Knowledge and awareness of chronic poisoning is less defined and probably there is a great number of patients with undiagnosed chronic CO poisoning. It is possible that in case of missed diagnosis because of non-specific symptoms, chronic CO poisoning could be responsible for significant morbidity. We describe the case of a married couple who were rescued almost simultaneously, to show this clinical condition.

Neuroimaging, Cognitive, and Neurobehavioral Outcomes Following Carbon Monoxide Poisoning

Carbon monoxide is a colorless, odorless gas produced as a byproduct of combustion. Carbon monoxide is the leading cause of poisoning injury and death worldwide. Morbidity following CO poisoning includes neurologic sequelae, neuropathologic abnormalities on brain imaging, neurobehavioral changes, and cognitive impairments. It is estimated that as high as 50% of individuals with carbon monoxide poisoning will develop neurologic, neurobehavioral, or cognitive sequelae. Carbon monoxide related cognitive impairments included impaired memory, attention, executive function, motor, visual spatial, and slow mental processing speed. Given the high rate of brain related morbidity and the fact that the majority of carbon monoxide is avoidable, awareness and prevention of carbon monoxide poisoning is warranted.

Formic acid: a rare but deadly source of carbon monoxide poisoning

INTRODUCTION

Formic acid decomposes upon contact with strong acids producing carbon monoxide. Carbon monoxide poisoning from such a source, however, is extremely rare.

CASE REPORT

A 26-year-old man committed suicide by mixing 2.5 L of formic acid and 2.5 L of sulfuric acid in three beakers and staying in a closed room. The 53-year-old father performed cardiopulmonary resuscitation on his son but soon lost consciousness. In hospital, he initially manifested coma, hypoxemia, metabolic acidosis, and a carboxyhemoglobin level of 45.8%. He was treated with hyperbaric oxygen but developed acute respiratory distress syndrome on day four despite an early improvement. He was successfully weaned from the ventilator on day 8. The 53-year-old mother felt dizziness, headache and had a carboxyhemoglobin level of 23.0%. Her symptoms improved after oxygen therapy.

DISCUSSION AND CONCLUSIONS

Formic acid is a highly fatal source of carbon monoxide poisoning when mixed with sulfuric acid. In addition to the toxicities of carbon monoxide, concomitant inhalation of formic acid fumes can cause severe lung injury, which may complicate the management of carbon monoxide poisoning.

Carbon-monoxide poisoning, behavioural changes and suicide: an unusual industrial accident

We report a case of CO intoxication caused by a motor vehicle's faulty heating-system. A truck driver experienced severe mental deterioration, behavioural changes and delirium after acute CO intoxication and committed suicide 15 months later. This report examines the pathogenetic mechanism of CO, the immediate and delayed consequences of CO intoxication, diagnostic difficulties and current treatment options. The medical-legal aspects of the case are discussed.

Carbon monoxide poisoning: a review for clinicians

Carbon monoxide (CO) poisoning continues to be a significant health problem both in the United States and in many other countries. CO poisoning is associated with a high incidence of severe morbidity and mortality. Epidemics of CO poisoning commonly occur during winter months and sources include: smoke from fires, fumes from heating systems burning fuels, and exhaust fumes from motor vehicles. The history of exposure and carboxyhemoglobin levels should alert the physician to this diagnosis. In the absence of exposure history, CO poisoning should be considered when two or more patients are simultaneously sick. The clinical presentation is non-specific and may range from nausea and headache to profound central nervous system dysfunction. The mainstay of therapy for CO poisoning is supplemental oxygen, ventilatory support, and monitoring for cardiac dysrhythmias. This article reviews up-to-date information of this potentially devastating exposure.

Emergency department visits for carbon monoxide poisoning in the Pacific Northwest

This study was conducted to determine the annual number of emergency department (ED) visits and rate of hyperbaric oxygen (HBO2) treatment for carbon monoxide (CO) poisoning in Washington, Idaho, and Montana. All hospital emergency departments and hyperbaric treatment facilities in the region were surveyed by mail and telephone regarding their patient treatment experience for calendar year 1994. Results demonstrated that there were approximately 2.51 million total ED visits in 1994 in the three states studied. Among these, an estimated 1,325 individuals were seen with carbon monoxide poisoning (52.9 CO cases per 100,000 ED visits; 18.1 CO cases per 100,000 population). A total of 91 patients were treated with HBO2, yielding an HBO2 treatment rate of 6.9% of those evaluated in EDs. Extrapolating these figures to the US population suggests that the number of individuals seeking emergency medical care for CO poisoning is much greater than is commonly quoted. Even after correcting for the known increased rate of CO poisoning in the Pacific Northwest, the incidence of nonfatal poisoning appears to be significantly higher than may be appreciated from previous reports.

Multidisciplinary rehabilitation management of depression in the carbon monoxide injured patient

Carbon monoxide (CO) is one of the common inhaled intoxicants used in attempting suicide. This case report describes the multidisciplinary rehabilitation management of suicidal CO poisoning in a 13-year-old initially comatose male patient. Despite the prevalence of self-inflicted CO poisoning, this is the first detailed case report emphasizing the acute and delayed neuropsychiatric sequelae of CO poisoning in the premorbidly depressed patient. In addition, the difficulty of assessing psychiatric illness in an acutely neurologically impaired patient is discussed.