Last reviewed: 26 Aug 2021
Last updated: 06 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • risk of carbon monoxide exposure
  • headache
  • nausea
  • vomiting
  • vertigo
  • altered consciousness
  • dizziness
  • dyspnoea
  • pain
  • sleep changes
  • emotional lability

Other diagnostic factors

  • delayed neuropsychiatric features
  • other severe neurological symptoms
  • focal neurological abnormalities

Risk factors

  • exposure to incomplete combustion of carbon-containing material
  • exposure to methylene chloride

Diagnostic investigations

1st investigations to order

  • blood gas analysis
  • 12-lead ECG
  • blood pressure
  • cardiac monitoring
  • glucose
  • full blood count
  • urea and electrolytes
  • troponin
  • creatine kinase

Investigations to consider

  • mini-mental state examination
  • CT head
  • magnetic resonance spectroscopy
  • chest x-ray
  • liver function tests

Treatment algorithm

Contributors

Expert advisers

Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, Dip IMC RCSEd

Flight Doctor

Greater Sydney Area Helicopter Emergency Medical Service

Sydney

Australia

Disclosures

AA declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Jason J Rose, MD, MBA

Assistant Professor of Medicine and Biomedical Engineering

University of Pittsburgh

Pittsburgh

PA

Disclosures: JJR is a co-inventor on patent applications for the use of heme-based molecules as antidotes for CO poisoning. JJR is a shareholder, officer, and director of Globin Solutions, Inc. Globin Solutions, Inc. has an exclusive license to this technology. Globin Solutions, Inc. had an option agreement to technology directed at using hydroxycobalamin for CO poisoning from Virginia Commonwealth University in the last 12 months. JJR is an author of publications cited within this topic.

Peer reviewers

Robert Taylor, MBChB, MRCP(UK), MRCP(London), DipMedTox, DipTher PGDME, FHEA FRCEM

Acute Hospital Sub Dean (Cornwall)

Honorary Clinical Senior Lecturer

Consultant Emergency Physician

University of Exeter Medical School

Royal Cornwall Hospitals NHS trust

Truro

UK

Disclosures

RT declares that he has no competing interests.

Editors

Emma Quigley,

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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