Carbon monoxide poisoning

Diagnosis (Rose et al, 2017; Weaver 2009)

The diagnosis is made by a combination of symptoms as well as spectrophotometric CO-oximetry with >3% in nonsmokers and >10% in smokers being diagnostic.

• The levels, however, do not correlate very well with the clinical picture.
• Headache and dizziness are the most common presenting symptoms, and unfortunately nonspecific.
  • More severe clinical signs include hypotension, cardiac arrhythmias, myocardial ischemia, coma, respiratory depression, noncardiogenic pulmonary edema, or seizures.
  • Neuroimaging
  • the most common brain imaging findings are white matter hyperintensities
  • hippocampal atrophy is also common as late sequelae
  • though the ischemia-sensitive globus pallidus can be involved, it’s not the most common site.

Treatment

• Longer term cognitive consequences may benefit from acetylcholinesterase inhibitor as treatment for delayed encephalopathy related to carbon monoxide poisoning (Yanagiha, Ishii, and Tamaoka, 2017)

References

Rose, J. J. et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am. J. Respir. Crit. Care Med. 195, 596–606 (2017). https://pubmed.ncbi.nlm.nih.gov/27753502/

Weaver, L. K. Carbon Monoxide Poisoning. N. Engl. J. Med. 9 (2009). https://pubmed.ncbi.nlm.nih.gov/19297574/

Yanagiha, K., Ishii, K. & Tamaoka, A. Acetylcholinesterase inhibitor treatment alleviated cognitive impairment caused by delayed encephalopathy due to carbon monoxide poisoning: Two case reports and a review of the literature. Medicine (Baltimore) 96, e6125 (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569429/