Carbon Monoxide Poisoning

Carbon monoxide (CO) is the most commonly encountered toxic gas. It is an odorless gas that is a by-product of incomplete combustion of carbon, such as from burning of natural gas, gasoline, or other petroleum products. It is present in exhaust from automobile engines or natural gas furnaces or water heaters. It also is a product of structure fires, and so a commonly encountered toxin in firefighters. It is a by-product of cigarette smoking both for the smoking individual and for those inhaling secondhand smoke. People become exposed through these routes, especially from auto exhaust, gas leaks, or secondhand smoke.

Minimal amounts of carbon monoxide dissolve in the aqueous or lipid layer of tissues or fluids. Most of the carbon monoxide, like oxygen, binds to hemoglobin and myoglobin. However, carbon monoxide has a much stronger affinity for hemoglobin than does oxygen. The resulting compound that forms is termed carboxyhe-moglobin.

Rarely, carboxyhemoglobin is formed from the metabolism of other chemicals. An unusual source of CO exposure is from inhalation of paint remover containing dichloromethane, which is metabolized to carbon monoxide in the body. Also, trace amounts of carboxyhemoglobin form in moderate to severe cases of hemolytic anemia and in gastrointestinal (GI) bleeding, further complicating those conditions.

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