Fatal Carbon Monoxide Poisoning Research Articles

Barbecue charcoal burning: an alternative means of carbon monoxide suicide

Intentional carbon monoxide poisoning is most commonly achieved by inhaling exhaust fumes from a vehicle in a confined space. However, there are a small proportion of cases which utilise barbeque (BBQ) charcoal to produce fatal carbon monoxide levels. This method is most prominently observed throughout East/Southeast Asia and such cases demonstrate consistent demographic and socioeconomic trends,1 particularly those in Korea (young males in cars).2 However, suicides utilising this method in other countries occur in lower numbers and exhibit markedly different profiles. The current study was undertaken to analyse rates of charcoal-burning suicides in South Australia (SA) as a point of comparison against existing Asian and European studies. A total of 502 carbon monoxide-related deaths occurred in SA between 2000–2019. Of those, 20 cases (4%) involved burning BBQ charcoal resulting in fatal carbon monoxide poisoning, 18 (90%) of which were suicides. While no significant demographic trends were identified due to limited reporting of nationality, 78% of decedents were male and were found either in the bathroom (n=4), bedroom (n=3) or loungeroom (n=2) of their home address or seated in a vehicle (n=9). While demographic trends were not significant, BBQ charcoal burning appears to be associated with intentional self-harm rather than inadvertent exposure.

Double deaths due to domestic carbon monoxide poisoning correlated with medicolegal autopsy and laboratory studies

Carbon monoxide poisoning is one of the most prevalent types of accidental poisoning worldwide, especially in houses and hotels with malfunctioning or badly maintained appliances. Most carbon monoxide poisoning cases remain undetected because of common symptoms of flu and lack of knowledge. Two people died as a result of unintentional carbon monoxide poisoning in the restroom, which we reported. On the next day of Valentine's Day, a boy and a girl, both about 23 years old and healthy students, were discovered dead inside a bathroom in a compromised position. Medicolegal autopsy revealed the Cherry-red discolouration of the skin, mucous membranes, conjunctivae, nail beds, and areas of hypostasis was seen in both the deceased. Further analysis of the crime scene reveals that the bathroom lacks adequate aeration. Suggestive of a carbon monoxide poisoning which was later confirmed in laboratory analysis of post-mortem blood by UV visible spectrophotometry revealed the presence of dangerous levels of carboxyhaemoglobin i.e., 38.27% in male and 36.79% in female. This method of detecting carboxyhaemoglobin in blood is easy and inexpensive. This case serves to increase awareness of fatal carbon monoxide poisoning by gas geysers. Carbon monoxide poisoning is linked to a high death and morbidity rate. Due to the rising usage of gas water heaters in homes, public awareness of the hazards associated with carbon monoxide, with an emphasis on preventive measures at home, is essential for avoidance.

Carbon monoxide-related fatalities: A 60-year single institution experience

ObjectiveThough carbon monoxide (CO) poisonings account currently for a relatively small percentage of total non-natural deaths in Europe, they represent a serious public health burden and significant component of avoidable mortality in many countries. Our aim was to investigate long-term trends and to determine epidemiologic characteristics of the CO-related deaths in the Czech Republic, recorded at the Department of Forensic Medicine in Hradec Králové. MethodsThis was an autopsy-based single-centre retrospective cohort study of all fatalities caused by CO poisoning over six decades (1947–2006). All data were numerically evaluated and processed using NCSS 10 Statistical Software. Statistical significance was defined as a p-value less than 0.05. ResultsA total of 1233 CO-related deaths were identified for inclusion in the study. The manner of death was ranked in order as follows: 45% accidental poisoning, 40% suicidal poisoning, 1% homicidal poisoning, 14% remained undetermined. There were slightly more male victims (59%) than female, and the mean age overall was 48 years. The majority of CO-related fatalities were attributed to coal gas inhalation, with the remainder being from inhaled motor vehicle exhaust fumes, inhaled fire smoke, and other combustion sources such as charcoal, gas and wood-burning appliances. The mean blood carboxyhemoglobin (COHb) level was 66%. A positive blood ethanol concentration was measured in 455 (37%) cases examined. Non-intentional poisonings were highly correlated with the winter months. ConclusionThis study shows that the prevalence of CO-related deaths has decreased significantly in the Czech Republic following the widespread detoxification of the domestic gas in the 1990–1995. Our findings suggest that acute ethanol use, poorer socioeconomic position, and inadequate education status about the danger of CO are associated with an increased risk of fatal CO poisoning. Finally, our results demonstrate the continued value of the autopsy in monitoring global public health security issues and socioeconomic situation. Further similar large-scale studies in different populations are needed to improve the targeting of interventions to the groups with the highest level of risk, and to understand the sources of variation in CO-related mortality.

Fatal carbon monoxide poisoning: A lesson from a retrospective study at All India Institute of Medical Sciences, New Delhi.

Background:Carbon monoxide (CO) is a colorless, odorless, tasteless, and nonirritating gas which makes it difficult for those who are exposed, to detect it, leading to unexpected death. This study was undertaken to see the pattern of fatal CO poisoning and to discuss preventive aspect.Materials and Methods:It was a retrospective descriptive study of fatal CO cases which were autopsied at All India Institute of Medical Sciences, New Delhi, from the year 2010 to the year 2015. The cases were analyzed as per age groups, circumstances of death, season of death, and sources of CO formation.Results and Discussion:The study involved 40 cases of fatal CO poisoning. About 80% of cases were reported in winter months. The maximum cases were reported in the month of January followed by November and December. All the cases except one, died with a source of CO nearby and the person was inside a room or some closed space without ventilation. Source of CO was firepot and electric room heater in most of the cases. Some cases were of CO build inside the car with a running engine. Most of the cases occurred accidentally.Conclusion:Clustering of cases is seen in winters. Poisoning can occur in different ways. The study documents the various possibilities of CO poisoning and advocates community education targeting the high-risk groups and masses, especially during the winter season.

The Effect of Fatal Carbon Monoxide Poisoning on the Surface Charge of Blood Cells

The objective of this investigation was to evaluate postmortem changes of electric charge of human erythrocytes and thrombocytes after fatal carbon monoxide (CO) poisoning. The surface charge density values were determined on the basis of the electrophoretic mobility measurements of the cells carried out at various pH values of electrolyte solution. The surface charge of erythrocyte membranes after fatal CO poisoning as well as after sudden unexpected death increased compared to the control group in the whole range of experimental pH values. Also, a slight shift of the isoelectric point of erythrocyte membranes to high pH values was observed. The surface charge of thrombocyte membranes after fatal CO poisoning decreased at low pH compared to the control group. However, at high pH, the values increased compared to the control group. The isoelectric point of thrombocyte membranes after fatal CO poisoning was considerably shifted toward low pH values compared to the control group. The observed changes are probably connected with the destruction of blood cell structure.

Fatal carbon monoxide poisoning: an outdoor occupational accident case

Fatal carbon monoxide (CO) poisoning by suicide or accident is well known. Most cases are due to smoke from burning buildings, town gas and car exhaust gas all in closed...

Diesel Fumes Do Kill: A Case of Fatal Carbon Monoxide Poisoning Directly Attributed to Diesel Fuel Exhaust with a 10‐year Retrospective Case and Literature Review*

While it is known that diesel fuel combustion engines produce much lower concentrations of carbon monoxide (CO) than gasoline engines, these emissions could certainly generate lethal ambient concentrations given a sufficient amount of time in an enclosed space and under suitable environmental conditions. The authors report a case of CO poisoning which was initially referred for autopsy as a presumed natural death of a truck driver found in the secure cab of a running diesel tractor trailer truck. Completion of the preliminary investigation ascribed death to complications of ischemic heart disease (IHD), pending toxicological analysis that included quantification of CO. When the toxicology results showed lethal blood COHbg, the cause of death was re-certified as CO intoxication secondary to inhalation of (diesel) vehicular exhaust fumes. Because of the unique source of fatal CO intoxication in this case, the contributory IHD and the possible contaminants in the putrefied blood, a 10-year retrospective review was conducted on all nonfire related CO deaths autopsied (n = 94) at the Office of the Chief Medical Examiner in Louisville, KY from 1994 to 2003. For validation of the COHbg detection method used by the Kentucky Office of Forensic Toxicology (KYOFT), blood samples from these cases along with controls were submitted to three laboratories using various analytical methods yielding no statistically significant differences. Lastly, an extensive literature review produced no scientifically reported cases of fatal CO poisoning attributed to diesel fuel exhaust.

Improved outcome with organs from carbon monoxide poisoned donors for intrathoracic transplantation

Background. The success of intrathoracic organ transplantation has lead to a growing imbalance between the demand and supply of donor organs. Accordingly, there has been an expansion in the use of organs from nonconventional donors such as those who died from carbon monoxide poisoning. We describe our experience with 7 patients who were transplanted using organs after fatal carbon monoxide poisoning. Methods. A retrospective study of the 1,312 intrathoracic organ transplants between January 1979 and February 2000 was completed. Seven of these transplants (0.5%) were fulfilled with organs retrieved from donors after fatal carbon monoxide poisoning. There were six heart transplants and one single lung transplant. The history of carbon monoxide inhalation was obtained in all of these donors. Results. Five of 6 patients with heart transplant are alive and well with survival ranging from 68 to 1,879 days (mean, 969 ± 823 days). One patient (a 29-year-old male) died 12 hours posttransplant caused by donor organ failure. The patient who had a right single lung transplant did well initially after the transplant, but died after 8 months caused by Pneumocystis carinii pneumonia. All those recipients who were transplanted from carbon monoxide poisoned donors and ventilated for more than 36 hours, survived for more than 30 days. Moreover, these donors were assessed and optimized by the Papworth donor management protocol. Conclusions. Carbon monoxide poisoned organs can be considered for intrathoracic transplantation. In view of the significant risk of donor organ failure, a cautious approach is still warranted. Ideally, the donor should be hemodynamically stable for at least 36 hours from the time of poisoning and on minimal support. A formal approach of invasive monitoring and active management further improves the chances of successful outcome.

Carbon Monoxide Poisoning

A review is presented of 302 cases in East Denmark in 1982-1986 in which the manner of death was fatal carbon monoxide (CO) poisoning. The incidence of this far too frequent single-substance poisoning has as yet not decreased over the years despite preventive measures. The number of fatal CO poisoning cases may diminish as a result of a natural gas project in progress. The purpose of this survey, therefore, is to contribute to the evaluation of the actual causes of these fatal poisonings in East Denmark, and to discuss existing measures that prevent gas poisonings, in the expectation of a decline both in gas suicides and in accidental gas poisonings within the next few years.

Echocardiographic findings after acute carbon monoxide poisoning.

Myocardial lesions are frequently seen at necropsy after fatal carbon monoxide poisoning. Clinically, while there have been numerous reports of chest pain and electrocardiographic changes associated with acute carbon monoxide poisoning, other evidence for left ventricular abnormality has not been reported. The echocardiographic findings in five cases of non-fatal poisoning are presented here. Abnormal left ventricular wall motion was shown by echocardiography in 3 cases. Motion returned to normal in 2 of the 3 in follow-up tracings. Echocardiograms on 3 of the 5 patients showed mitral valve prolapse. Though the mitral valve prolapse may have been present before the poisoning, the reported high incidence of papillary muscle lesions in fatal cases suggests a possible relation of the prolapse to the effects of the carbon monoxide poisoning.