Carbon monoxide poisoning

Carbon monoxide poisoning continues to result in significant morbidity and mortality. It is produced from the incomplete combustion of carbon and can be colorless, odorless, and difficult to detect. It results in systemic toxicity by interfering with oxygen binding to hemoglobin as well as by inhibiting cytochrome oxidase that results in oxidative stress and lipid peroxidation. Carbon monoxide poisoning results in various systemic symptoms; however, neurologic symptoms tend to predominate. Diagnosis is made by measuring arterial or venous carboxyhemoglobin concentrations; however, illness severity does not always correlate with carboxyhemoglobin concentrations. Treatment involves removal from the exposure and administration of 100% high-flow oxygen. Hyperbaric oxygen may also be considered to enhance elimination, as well as, attenuate neurologic oxidative stress. Many patients recover completely but permanent neurologic sequelae are possible.