Carbon monoxide poisoning

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Última revisão: 17 Aug 2025

Última atualização: 19 Dec 2024

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.

Around 40% to 50% of survivors of CO poisoning suffer from delayed neurocognitive deficits that can become permanent.

Definición

Carbon monoxide (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]

Anamnesis y examen

Principales factores de diagnóstico

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

Todos los datos

Otros factores de diagnóstico

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

Todos los datos

Factores de riesgo

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

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

carboxyhemoglobin level
ECG
cardiac monitoring
blood glucose
complete blood count
urea and electrolytes
creatinine
lactate
pH level
cardiac biomarkers
creatine kinase

Todos los datos

Pruebas diagnósticas que deben considerarse

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

Todos los datos

Algoritmo de tratamiento

Agudo

all patients

Colaboradores

Consejeros especializados

Richard Moon, MD

Professor of Anesthesiology

Professor of Medicine

Division of Pulmonary, Allergy and Critical Care Medicine

Duke University

Durham

Divulgaciones

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

Agradecimientos

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

Divulgaciones

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.

Revisores por pares

Richard S. Weisman, PharmD

Director

Florida Poison Center

Miami

Divulgaciones

RSW declares that he has no competing interests.

Sean Patrick Nordt, MD, PharmD

Resident Physician

Department of Emergency Medicine

University of California

San Diego

Divulgaciones

SPN declares that he has no competing interests.

Paul Hamilton, MD

Director

Department of Emergency Medicine

Mount Sinai School of Medicine

New York

Divulgaciones

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

Divulgaciones

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.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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.Texto completo Resumen

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

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.Texto completo Resumen

Weaver LK. Carbon monoxide poisoning. Undersea Hyperb Med. 2020 First Quarter;47(1):151-69.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

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Carbon monoxide poisoning

Resumo

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

all patients

Colaboradores

Consejeros especializados

Richard Moon, MD

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Richard S. Weisman, PharmD

Divulgaciones

Sean Patrick Nordt, MD, PharmD

Divulgaciones

Paul Hamilton, MD

Divulgaciones

Ruben Thanacoody, MD, FRCP(Edin)

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice