Last reviewed: 20 Sep 2021
Last updated: 09 Jun 2020

Summary

Definition

History and exam

Key diagnostic factors

  • exposure to incomplete combustion of carbon-containing material
  • exposure to fire with smoke inhalation
  • nausea
  • headache
  • vomiting
  • blurred vision
  • dizziness
  • cutaneous blistering
  • tachycardia
  • hypotension
  • cardiac arrhythmias
  • pulmonary edema
  • confusion
  • coma

Other diagnostic factors

  • exposure to methylene chloride
  • seizures
  • focal neurologic abnormalities (e.g., hemiplegia)

Risk factors

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

Diagnostic investigations

1st investigations to order

  • carboxyhemoglobin level
  • ECG
  • cardiac monitoring
  • blood glucose
  • lactate
  • pH level
  • cardiac biomarkers

Investigations to consider

  • chest x-ray
  • creatine kinase
  • Mini Mental State Examination
  • CT head

Emerging tests

  • magnetic resonance spectroscopy

Treatment algorithm

Contributors

Authors

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.

Acknowledgements

Dr Jason Rose would like to gratefully acknowledge Dr Prasanthi Govindarajan, a previous contributor to this topic. PG declares that she has no competing interests.

Peer reviewers

Richard S. Weisman, PharmD

Director

Florida Poison Center

Miami

FL

Disclosures

RSW declares that he has no competing interests.

Sean Patrick Nordt, MD, PharmD

Resident Physician

Department of Emergency Medicine

University of California

San Diego

CA

Disclosures

SPN declares that he has no competing interests.

Paul Hamilton, MD

Director

Department of Emergency Medicine

Mount Sinai School of Medicine

New York

NY

Disclosures

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

UK

Disclosures

RT declares that he has no competing interests.

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