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Carbon monoxide poisoning

Last reviewed: 10 Nov 2024
Last updated: 21 Nov 2023

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
  • vertigo
  • altered consciousness
  • dyspnea
  • tachycardia
  • hypotension or hypertension
  • cardiac arrhythmias
  • pain
  • weakness
  • sleep changes
  • irritability
  • flu-like symptoms
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

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

Diagnostic tests

1st tests to order

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

Tests to consider

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

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Richard Moon, MD

Professor of Anesthesiology

Professor of Medicine

Division of Pulmonary, Allergy and Critical Care Medicine

Duke University

Durham

NC

Disclosures

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

Acknowledgements

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

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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