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Savioli G, Gri N, Ceresa IF, Piccioni A, Zanza C, Longhitano Y, Ricevuti G, Daccò M, Esposito C, Candura SM. Carbon Monoxide Poisoning: From Occupational Health to Emergency Medicine. J Clin Med 2024; 13:2466. [PMID: 38730995 PMCID: PMC11084260 DOI: 10.3390/jcm13092466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/20/2024] [Accepted: 04/09/2024] [Indexed: 05/13/2024] Open
Abstract
Carbon monoxide poisoning remains a leading cause of accidental poisoning worldwide (both at home and at work), and it is also a cause of suicidal poisoning. Such poisoning can arise following prolonged exposure to low levels of CO or following brief exposure to high concentrations of the gas. In fact, despite exposure limits, high safety standards, and the availability of CO alarms, nearly 50,000 people in the United States visit the emergency department each year due to poisoning. Additionally, CO poisoning in the United States causes up to 500 deaths each year. Despite the widespread nature of this form of poisoning, known about for centuries and whose damage mechanisms have been recognized (or rather hypothesized about) since the 1800s, early recognition, especially of late complications, and treatment remain a medical challenge. A well-designed therapeutic diagnostic process is necessary so that indication for hyperbaric or normobaric therapy is correctly made and so that patients are followed up even after acute exposure to diagnose late complications early. Furthermore, it is necessary to consider that in the setting of emergency medicine, CO poisoning can be part of a differential diagnosis along with other more frequent conditions, making its recognition difficult. The last thirty years have been marked by a significant increase in knowledge regarding the toxicity of CO, as well as its functioning and its importance at physiological concentrations in mammalian systems. This review, taking into account the significant progress made in recent years, aims to reconsider the pathogenicity of CO, which is not trivially just poisonous to tissues. A revision of the paradigm, especially as regards treatment and sequelae, appears necessary, and new studies should focus on this new point of view.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy;
| | - Iride Francesca Ceresa
- Emergency Department and Internal Medicine, Istituti Clinici di Pavia e Vigevano—Gruppo San Donato, 27029 Vigevano, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15260, USA;
- Department of Emergency Medicine—Emergency Medicine Residency Program, Humanitas University—Research Hospital, 20089 Rozzano, Italy
| | - Giovanni Ricevuti
- Emergency Medicine, School of Pharmacy, University of Pavia, 27100 Pavia, Italy;
| | - Maurizio Daccò
- ATS Pavia, Continuità Assistenziale, Via Teodoro Lovati, 45, 27100 Pavia, Italy;
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Stefano M. Candura
- Occupational Medicine Unit, Department of Public Health, Experimental and Forensic Sciences, University of Pavia, 27100 Pavia, Italy
- Occupational Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
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Alehan F, Erol I, Onay OS. Cerebral palsy due to nonlethal maternal carbon monoxide intoxication. ACTA ACUST UNITED AC 2007; 79:614-6. [PMID: 17584908 DOI: 10.1002/bdra.20379] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Carbon monoxide (CO) poisoning in pregnancy is a relatively rare occurrence, but it can result in fetal mortality and neurologic complications in fetuses who survive to term. CASE We describe the course of an infant who was acutely exposed to CO at 20 weeks of gestation. CONCLUSIONS We conclude that despite maternal well-being, CO intoxication at critical periods of human brain development can lead to hypoxic-ischemic lesions in the globus pallidus and that dystonic cerebral palsy may develop in the infant during long-term follow-up.
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Affiliation(s)
- Füsun Alehan
- Department of Pediatrics, Neurology Division, Baskent University Faculty of Medicine, Ankara, Turkey
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Habek D. Effects of smoking and fetal hypokinesia in early pregnancy. Arch Med Res 2007; 38:864-7. [PMID: 17923268 DOI: 10.1016/j.arcmed.2007.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Accepted: 05/28/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to perform qualitative and quantitative ultrasound (US) monitoring of fetal movement in early pregnancy (gestational weeks 10-20) as a component of fetal behavior in women smokers. METHODS The study included three groups of 20 pregnant women each: non-smokers (group 1), smokers of an average of 10 cigarettes daily (group 2), and smokers of an average of >20 cigarettes daily (chronic smokers; group 3). Two-dimensional US study was performed once during gestational weeks 10-20 by the then standard method of fetal movement monitoring: 1) quantitative measurement of global fetal movements qualitatively verified as brisk or sluggish; 2) quantitative measurement of isolated spontaneous head movements; 3) quantitative measurement of isolated spontaneous arm movements; 4) quantitative measurement of isolated spontaneous leg movements; and 5) M-mode measurement of fetal heart rate. RESULTS The ratio of brisk to sluggish fetal movements was 82.8% to 17.2%, 79.01% to 20.98%, and 44.25% to 55.75% in groups 1, 2, and 3, respectively (p <0.001). The rate of isolated spontaneous head and arm movements and of the upper cerebral pattern (head and arm movements) was statistically significantly lower in group 3 as compared with groups 1 and 2 (p <0.001), whereas no statistical significance was recorded in isolated spontaneous leg movements (p >0.01). The rate of fetal tachycardia was also significant in group 3, whereas tachyarrhythmia was recorded in seven children born to group 3 mothers (p <0.001). CONCLUSIONS The present study of the effect of chronic tobacco hypoxia on the components of fetal behavior revealed a positive correlation between global and isolated fetal hypokinesia of the upper cerebral pattern (p <0.001), fetal tachycardia, and tachyarrhythmia in the group of mothers who were chronic smokers (p <0.001).
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Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, School of Medicine, Zagreb University, Sveti Duh Hospital, Zagreb, Croatia.
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Abstract
Carbon monoxide is an insidious poison that accounts for thousands of deaths each year in North America. Clinical effects maybe diverse and include headache, dizziness, nausea, vomiting,syn-cope, seizures, coma, dysrhythmias, and cardiac ischemia. Children, pregnant women, and patients who have underlying cardiovascular disease are particularly at risk for adverse out-comes. Treatment consists of oxygen therapy, supportive care, and, in selected cases, hyperbaric oxygen therapy.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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Abstract
CO is an ubiquitous poison with many sources of exposure. CO poisoning produces diverse signs and symptoms that are often subtle and may be easily misdiagnosed. Failure to diagnose CO poisoning may result insignificant morbidity and mortality and permit continued exposure to a dangerous environment. Treatment of CO poisoning begins with inhalation of supplemental oxygen and aggressive supportive care. HBOT accelerates dissociation of CO from hemoglobin and may also prevent DNS. Absolute indications forHBOT for CO poisoning remain controversial, although most authors would agree that HBOT is indicated in patients who are comatose or neurologically abnormal, have a history of LOC with their exposure, or have cardiac dysfunction. Pregnancy with an elevated CO-Hgb level(>15%-20%) is also widely, considered an indication for treatment.HBOT may be considered in patients who have persistent symptoms despite NBO, metabolic acidosis, abnormalities on neuropsychometric testing, or significantly elevated levels. The ideal regimen of oxygen therapy has yet to be determined, and significant controversy exists regarding HBOTtreatment protocols. Often the local medical toxicologist, poison control center, or hyperbaric unit may assist the treating physician with decisions regarding therapy.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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Abstract
CO is an insidious poison with many sources of exposure. CO poisoning produces diverse signs and symptoms, which often are subtle and can be misdiagnosed easily. Failure to diagnose CO poisoning may result insignificant morbidity and mortality and allow continued exposure to a dangerous environment. In the ED, a high index of suspicion must be maintained for occult CO exposure. Headache, particularly when associated with certain environments, and flulike illness in the wintertime with symptomatic cohabitants should raise the index of suspicion in the ED significantly for occult CO poisoning. Emergency treatment of CO poisoning begins with inhalation of supplemental oxygen and aggressive supportive care. HBOT accelerates dissociation of CO from hemoglobin and may prevent DNS. Absolute indications for HBOT for CO poisoning remain controversial, although most would agree that HBOT is indicated in patients who are comatose, are neurologically abnormal, have a history of loss of consciousness with their exposure, or have cardiac dysfunction. Pregnancy with an elevated CO-Hgb level (>15-20%) also is widely considered an indication for treatment. HBOT may be considered in patients who have persistent symptoms despite NBO, metabolic acidosis, abnormalities on neuropsychometric testing, or significantly elevated levels. The ideal regimen of oxygen therapy has yet to be determined, and significant controversy exists regarding HBOT protocols. The emergency physician may be confronted with the difficult decision regarding disposition and even transfer to a hyperbaric facility. Often the local medical toxicologist, poison control center, or hyperbaric unit can assist the emergency physician with the decision-making process.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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