Carbon Monoxide Poisoning

Introduction: Carbon monoxide is known as the silent killer, being colorless, odourless, and tasteless. Initially non-irritating, it is very difficult for people to detect Carbon monoxide is a product of incomplete combustion of organic matter due to insufficient oxygen supply that prevents complete oxidation of carbon to C02. During World War II, Nazis used gas vans to kill an estimated over 700,000 prisoners by carbon monoxide poisoning. This method was also used in the gas chambers ofseveral death camps. The true number of incidents of carbon monoxide poisoning is unknown, since many non-lethal exposures go undetected From the available data, carbon monoxide poisoning is the most common cause of injury and death due to poisoning worldwide. Clinical features and management: The signs of carbon monoxide poisoning vary with concentration and length of exposure. Subtle cardiovascular or neurobehavioural effects occur at low concentration. The onset of chronic poisoning is usually insidious and easily mistaken for viral prodrome, depression, or gastroenteritis in children. The classic sign of carbon monoxide poisoning which is actually more often seen in the dead than the living is appearing red-cheeked and healthy. Cherry pink colour develops in nails, skin and mucosa. In acute poisoning, common abnormalities of posture and tone are cogwheel rigidity, opisthotonus, spasticity or flaccidity and seizures. Retinal haemorrhages and the classic cherry red skin colour are seldom seen. Different people andpopulations may have different carbon monoxide tolerance levels. On average, exposures at 100ppm or greater is dangerous to human health. Treatment and prevention: The mainstay of treatment is 100% oxygen administration until the COHb level is normal When the patient is stable enough to be transported, hyperbaric oxygen (HBOT) should be considered This treatment is safe and well tolerated Public education about the danger of carbon monoxide, with emphasis on safety in the home and workplace, is the key to effective prevention. This could be achieved through a media campaign when risk is greatest, Le. during the winter. Close liaison between public health physicians and leaders of building, gas and home heating industries is a prerequisite for an effective prevention strategy