CARBON MONOXIDE POISONING - 08/09/11
Resumen |
Carbon monoxide (CO) poisoning is a very complex subject. The words “carbon monoxide” appear 939 times in journal titles and “carbon monoxide poisoning” appears 3801 times in a MedLine search dating back to 1966. There are thousands of additional references regarding CO poisoning for the 100 years before 1966. Given the large volume of information, it is difficult to profess to be knowledgeable about all aspects of CO poisoning. A few of the salient, important, and newer discoveries regarding CO are condensed in this article. A text by Jain71 (1990) discusses CO in detail. A more recent text (1996) edited by Penney103 provides a comprehensive review of CO poisoning. This article begins with a historical perspective of CO poisoning:
“How injurious to the head the smoke from nut oil can be is well known to those who write or read or do any sort of work by the light of lamps burning nut oil in a small, close room where there is no ventilating pipe. The whole room becomes full of smoke, and they come out with a severe headache, vertigo, and in a dazed condition. There is a very old observation that the fumes of a snuffed out lamp by causing hysterical convulsions, can snuff out the life of the foetus in the womb.”114
CO exposures to humans date back to prehistoric times when man became exposed to products of combustion. Aristotle (third century, bc) is credited with the first mention of the lethal effects of coal fumes: “Coal fumes lead to heavy head and death.” Inhabitants of Nuceria were killed by CO suffocation while in the baths (Hannibal, Carthage, 247 to 183 bc). Coal fumes were used for suicide and execution (e.g., suicide of Roman author Seneca, 65 ad); Cicero, Rome, 106 to 43 bc). A recent article gives compelling evidence that two Byzantine emperors had CO poisoning, one nonfatal (Julian the Apostate, ad 331 to 363). His successor, Jovian (ad 334 to 364) died of CO poisoning.78 Hippocrates (ad 500) made reference to “sleep[ing] in a cold room well covered up,” meaning that “it is healthier to sleep in a large room in order to breathe purer air,”114 as opposed to small rooms that very soon might fill with smoke and fumes from lights or heating sources. Priestley (England, 1772) described a combustible gas (CO) that burned with a bright blue flame. The first clinical description of coal gas poisoning was by Harmant (France, 1775), and LeBlanc (France, 1842) identified CO as the toxic substance in coal gas.104
CO poisoning has taken the lives of emperors as well as a famous tennis player, Vitas Geralitis.137 Even Princess Diana's untimely accidental death in August 1997 may have been linked to the adverse behavioral effects of CO poisoning. The driver of the Mercedes in which she was a passenger was found to have a postmortem carboxyhemoglobin (COHb) of 20.7%. It is presently unknown why his level was this high.120
In addition to the fatal effects of CO poisoning, it has been established for more than 100 years that CO can alter the sensorium and result in significant cognitive disabilities. There are hundreds of case reports presenting information regarding patients suffering the effects of CO poisoning. Few of them offer more, or as detailed information, than the elegant case presentation by Dr Linas in France in 1868.79
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| Address reprint requests to Lindell K. Weaver, MD, FACP, FCCP, FCCM, Hyperbaric Medicine, LDS Hospital, 8th Avenue & C Street, Salt Lake City, UT 84143, e-mail: LWEAVER@ihc.com |
Vol 15 - N° 2
P. 297-317 - avril 1999 Regresar al número
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- NEAR DROWNING
- Ramesh C. Sachdeva
- ELECTRICAL AND LIGHTNING INJURIES
- Subin Jain, Venkata Bandi
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