Carbon monoxide poisoning

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 10 Aug 2026

最后更新： 13 Jan 2026

Carbon monoxide (CO) poisoning results in significant morbidity and mortality.

Poisoning can occur following exposure to a variety of fire or nonfire sources, including gas and charcoal grills, motor vehicle exhaust and other engine exhausts in poorly ventilated spaces, and various industrial sources. It can also occur due to endogenous production by the liver after inhalational exposure to methylene chloride, a component of some paint strippers.

Early symptoms are nonspecific and include headache, dizziness, and nausea.

If symptoms of CO poisoning are suspected, individuals should leave the building or space immediately and call the emergency medical services.

Diagnosis is based on a clinical triad: history of CO exposure, elevated carboxyhemoglobin levels, and symptoms/signs consistent with CO poisoning.

Severe poisoning may result in cardiovascular manifestations (e.g., myocardial ischemia, myocardial infarction, cardiac dysfunction, dysrhythmias, cardiac arrest). Neurologic symptoms include acute stroke-like symptoms, altered mental status, confusion, coma, and syncope.

High-flow oxygen therapy and supportive therapy are key treatments. Hyperbaric oxygen therapy should be considered in select patients with a goal to prevent long-term and permanent neurocognitive dysfunction.

定义

CO is a poisonous gas produced through burning fuel. When inhaled in large quantities, CO enters the bloodstream and binds to hemoglobin molecules with a much greater affinity than oxygen, creating carboxyhemoglobin.[1] The binding of CO results in tissue hypoxia and impairment of cellular respiration, and direct effects of CO toxicity at the cellular level. CO poisoning can present in patients as a wide range of acute and chronic symptoms.[1][2]

病史和体格检查

关键诊断因素

exposure to incomplete combustion of carbon-containing material
exposure to fire with smoke inhalation
nausea
headache
vomiting
blurred vision
dizziness
vertigo
altered consciousness
dyspnea
tachycardia
hypotension or hypertension
cardiac arrhythmias
pain
weakness
sleep changes
irritability
flu-like symptoms

完整详情

其他诊断因素

exposure to methylene chloride
delayed neuropsychiatric features
other severe neurologic symptoms
cutaneous blistering
pulmonary edema
cardiac arrest
focal neurologic abnormalities (e.g., hemiplegia, truncal ataxia)
disseminated intravascular coagulation

完整详情

危险因素

exposure to incomplete combustion of carbon-containing material
exposure to fire with smoke inhalation
exposure to methylene chloride

完整详情

诊断性检查

首要检查

carboxyhemoglobin (CO-Hb) level
ECG
cardiac monitoring
blood glucose
complete blood count
urea and electrolytes
creatinine
lactate
pH level
cardiac biomarkers
creatine kinase

完整详情

需考虑的检查

chest x-ray
Mini Mental State Examination
CT head
magnetic resonance imaging and spectroscopy
liver function tests
pregnancy test

完整详情

治疗流程

急症处理

all patients

撰稿人

专家顾问

Richard Moon, MD

Professor of Anesthesiology

Professor of Medicine

Division of Pulmonary, Allergy and Critical Care Medicine

Duke University

Durham, NC

利益声明

RM has been reimbursed by Merck for contributions to the Merck Manual.

鸣谢

Dr. Richard Moon would like to gratefully acknowledge Dr Jason Rose and Dr Prasanthi Govindarajan, previous contributors to this topic.

利益声明

PG declares that she has no competing interests. JR is a co-inventor on patent applications for the use of heme-based molecules as antidotes for CO poisoning. JR 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. JR is an author of publications cited within this topic.

同行评议者

Richard S. Weisman, PharmD

Director

Florida Poison Center

Miami

利益声明

RSW declares that he has no competing interests.

Sean Patrick Nordt, MD, PharmD

Resident Physician

Department of Emergency Medicine

University of California

San Diego

利益声明

SPN declares that he has no competing interests.

Paul Hamilton, MD

Director

Department of Emergency Medicine

Mount Sinai School of Medicine

New York

利益声明

PH declares that he has no competing interests.

Ruben Thanacoody, MD, FRCP(Edin)

Consultant Physician and Clinical Toxicologist

Regional Drugs and Therapeutics Centre

Newcastle-upon-Tyne

利益声明

RT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Hampson NB, Piantadosi CA, Thom SR, et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med. 2012 Dec 1;186(11):1095-101.全文摘要

Centers for Disease Control and Prevention. Clinical guidance for carbon monoxide poisoning following disasters and severe weather. Jul 2024 [internet publication].全文

Wolf SJ, Maloney GE, Shih RD, et al; American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med. 2017 Jan;69(1):98-107.e6.全文摘要

Weaver LK. Carbon monoxide poisoning (reprinted from the 2023 hyperbaric indications manual 15(th) edition). Undersea Hyperb Med. 2024 Third Quarter;51(3):253-76. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Viral infection
- Alcohol intoxication
- Migraine
更多鉴别诊断
指南
- Clinical policy: a critical issue in the management of adult patients presenting to the emergency department with acute carbon monoxide poisoning
- Clinical guidance for carbon monoxide poisoning following disasters and severe weather
更多指南
患者教育信息
Carbon monoxide poisoning
更多患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明

Carbon monoxide poisoning

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

all patients

撰稿人

专家顾问

Richard Moon, MD

利益声明

鸣谢

利益声明

同行评议者

Richard S. Weisman, PharmD

利益声明

Sean Patrick Nordt, MD, PharmD

利益声明

Paul Hamilton, MD

利益声明

Ruben Thanacoody, MD, FRCP(Edin)

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录后可浏览 BMJ Best Practice 临床实践完整内容