Abstract
Carbon monoxide (CO) poisoning is a common cause of death, leading to morbidity and mortality worldwide. Features of the CO poisoning with low carboxyhemoglobin (COHb) levels remain to be characterized. This study collected a total of 307 CO poisoning cases from Shanghai Public Security Bureau, an official organization that handles the most complicated and life-threatening cases across Shanghai municipality in China, and regrouped these cases into three categories: group 1, 10% < COHb% < 30% (n = 58); group 2, 30% ≤ COHb% < 50% (n = 79); group 3, COHb% ≥ 50% (n = 170). Epidemiological, demographic, and forensic aspects of the CO poisoning cases, particularly those with low COHb levels, were analyzed. Our results showed that group 2 and 3 were mostly observed in younger victims (≤ 30 years), while group 1 equally distributed to all age groups (p = 0.03). All the CO poisoning from group 2 and 3 occurred in enclosed spaces, whereas cases from group 1 died additionally in outdoor spaces (p = 0.01). 81.03% of group 1 cases died in fire circumstances, while only 45.57% from group 2 and 30.59% from group 3 were fire-related (p = 0.00). Accordingly, group 1 was mostly related with fire burns, while group 2 or 3 were largely associated with gas leakage (p = 0.00). A combination with alcohol, but not other psychotropic drugs, associated with significant higher levels of blood COHb% in fire-unrelated (p = 0.021) but not fire-related cases (p = 0.23). Five extremely low COHb% (< 30%)-related poisoning deaths were negative of any cardiopulmonary pathology and psychoactive substances. In conclusion, CO poisoning with low COHb% significantly associates with fire circumstances and outdoor spaces and has no age preference. Further diagnostic markers mandates to be identified in order to avoid disputes in cases of extremely low COHb%-related poisoning.
Highlights
Carbon monoxide (CO) is a colorless, odorless, non-irritant toxic gas which can cause harm to human body for its toxic effects ranging from cardiovascular and respiratory impairment to neuropsychiatric presentations and other acute c omplications[1,2]
Acute CO poisoning always leads to hypotension and ischemia in the arterial border zones of the brain which accompany with loss of c onsciousness[5]
A total of 307 deaths were due to acute CO poisoning
Summary
Carbon monoxide (CO) is a colorless, odorless, non-irritant toxic gas which can cause harm to human body for its toxic effects ranging from cardiovascular and respiratory impairment to neuropsychiatric presentations and other acute c omplications[1,2]. CO poisoning is the most common and plausible cause of fatal intoxication in circumstances of enclosed spaces (personal residents or public indoor spaces) or even outdoor places such as fire disasters. The main CO poisoning mechanism is related to its combination with haemoglobin forming carboxyhaemoglobin (COHb), due to its higher affinity to haemoglobin, preventing the oxygen transportation and its use by cells and tissues. Once CO is inhaled, it binds with hemoglobin to form carboxyhemoglobin (COHb) with an affinity 200 times greater than oxygen that leads to decreased oxygen-carrying capacity, decreased release of oxygen to tissues and local h ypoxia[5]. Acute CO poisoning always leads to hypotension and ischemia in the arterial border zones of the brain which accompany with loss of c onsciousness[5]
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