Carbon monoxide poisoning

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Última revisão: 13 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.

Definição

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]

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

Colaboradores

Consultores especialistas

Richard Moon, MD

Professor of Anesthesiology

Professor of Medicine

Division of Pulmonary, Allergy and Critical Care Medicine

Duke University

Durham

Declarações

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

Agradecimentos

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

Declarações

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

Richard S. Weisman, PharmD

Director

Florida Poison Center

Miami

Declarações

RSW declares that he has no competing interests.

Sean Patrick Nordt, MD, PharmD

Resident Physician

Department of Emergency Medicine

University of California

San Diego

Declarações

SPN declares that he has no competing interests.

Paul Hamilton, MD

Director

Department of Emergency Medicine

Mount Sinai School of Medicine

New York

Declarações

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

Declarações

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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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 Resumo

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 Resumo

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

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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- Clinical guidance for carbon monoxide poisoning following disasters and severe weather
- Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning
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Carbon monoxide poisoning

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Consultores especialistas

Richard Moon, MD

Declarações

Agradecimentos

Declarações

Revisores

Richard S. Weisman, PharmD

Declarações

Sean Patrick Nordt, MD, PharmD

Declarações

Paul Hamilton, MD

Declarações

Ruben Thanacoody, MD, FRCP(Edin)

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice