Unintentional Carbon Monoxide Research Articles

The spectrum of presentations of unintentional carbon monoxide poisoning.

Carbon monoxide (CO) is an odourless and tasteless gas which can be produced by the incomplete combustion of carbon-containing fuels. Compared to vehicular CO suicides, unintentional cases (excluding those related to fires) are much less common. Increased education surrounding the risks associated with the accumulation of CO in enclosed spaces has contributed to a reduced incidence of unintentional CO poisonings. However, such cases may remain undetected, particularly in domestic and recreational settings where scene findings are often non-specific. The current study of unintentional CO poisonings in South Australia and the Northern Territory, each with a unique climate (Mediterranean and tropical respectively), demonstrated differences in the circumstances of death. Several cases where individuals used carbon-producing fuel sources for heat, both in domestic and vehicular settings and without adequate ventilation, resulted in fatal outcomes. Less common scenarios involved faults in equipment (e.g. a hot water heater), vehicle faults resulting in the accumulation of fatal levels of CO in enclosed spaces, and inadvertent introduction of CO into a diving oxygen supply in a recreational aquatic setting. In ascertaining the cause of death, other considerations include the potential role of underlying chronic cardiovascular and respiratory disease and age which may increase an individual's susceptibility to CO toxicity. Understanding the wide variety of presentations and contributing factors in cases of fatal CO poisoning including consideration of climate-specific differences in domestic and extra-domestic settings may enable improved detection at autopsy.

Global, regional, and national mortality due to unintentional carbon monoxide poisoning, 2000–2021: results from the Global Burden of Disease Study 2021

Unintentional carbon monoxide poisoning is a largely preventable cause of death that has received insufficient attention. We aimed to conduct a comprehensive global analysis of the demographic, temporal, and geographical patterns of fatal unintentional carbon monoxide poisoning from 2000 to 2021. As part of the latest Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), unintentional carbon monoxide poisoning mortality was quantified using the GBD cause of death ensemble modelling strategy. Vital registration data and covariates with an epidemiological link to unintentional carbon monoxide poisoning informed the estimates of death counts and mortality rates for all locations, sexes, ages, and years included in the GBD. Years of life lost (YLLs) were estimated by multiplying deaths by remaining standard life expectancy at age of death. Population attributable fractions (PAFs) for unintentional carbon monoxide poisoning deaths due to occupational injuries and high alcohol use were estimated. In 2021, the global mortality rate due to unintentional carbon monoxide poisoning was 0·366 per 100 000 (95% uncertainty interval 0·276-0·415), with 28 900 deaths (21 700-32 800) and 1·18 million YLLs (0·886-1·35) across all ages. Nearly 70% of deaths occurred in males (20 100 [15 800-24 000]), and the 50-54-year age group had the largest number of deaths (2210 [1660-2590]). The highest mortality rate was in those aged 85 years or older with 1·96 deaths (1·38-2·32) per 100 000. Eastern Europe had the highest age-standardised mortality rate at 2·12 deaths (1·98-2·30) per 100 000. Globally, there was a 53·5% (46·2-63·7) decrease in the age-standardised mortality rate from 2000 to 2021, although this decline was not uniform across regions. The overall PAFs for occupational injuries and high alcohol use were 13·6% (11·9-16·0) and 3·5% (1·4-6·2), respectively. Improvements in unintentional carbon monoxide poisoning mortality rates have been inconsistent across regions and over time since 2000. Given that unintentional carbon monoxide poisoning is almost entirely preventable, policy-level interventions that lower the risk of carbon monoxide poisoning events should be prioritised, such as those that increase access to improved heating and cooking devices, reduce carbon monoxide emissions from generators, and mandate use of carbon monoxide alarms. Bill & Melinda Gates Foundation.

Morbidity and Mortality of Unintentional Carbon Monoxide Poisoning: United States 2005 to 2018.

Centers for Disease Control and Prevention conducts case surveillance through the National Notifiable Diseases Surveillance System (NNDSS). This study aimed to provide surveillance report of unintentional carbon monoxide poisoning across multiple data sources to provide baseline data for the new NNDSS carbon monoxide poisoning surveillance. For the period 2005 to 2018, we used 4 data sources to describe unintentional carbon monoxide poisoning: exposures reported by poison centers, emergency department (ED) visits, hospitalizations, and deaths. We conducted descriptive analyses by the cause of exposure (fire, nonfire, or unknown), age, sex, season, and US census region. Additional analyses were conducted using poison center exposure case data focusing on the reported signs and symptoms, management site, and medical outcome. Annually, we observed 39.5 poison center exposure calls (per 1 million, nationally), 56.5 ED visits (per 1 million, across 17 states), 7.3 hospitalizations (per 1 million, in 26 states), and 3.3 deaths (per 1 million, nationally) due to unintentional carbon monoxide poisoning. For 2005 to 2018, there was a decrease in the crude rate for non-fire-related carbon monoxide poisonings from hospital, and death data. Non-fire-related cases comprised 74.0% of ED visits data, 60.1% of hospitalizations, and 40.9% of deaths compared with other unintentional causes. Across all data sources, unintentional carbon monoxide poisonings were most often reported during the winter season, notably in January and December. Children aged 0 to 9 years had the highest reported rates in poison center exposure case data and ED visits (54.1 and 70.5 per 1 million, respectively); adults older than 80 years had the highest rates of hospitalization and deaths (20.2 and 9.9 per 1 million, respectively); and deaths occurred more often among men and in the Midwest region. Poison center exposure call data revealed that 45.9% of persons were treated at a health care facility. Headaches, nausea, and dizziness/vertigo were the most reported symptoms. The crude rates in non-fire-related carbon monoxide poisonings from hospitalizations, and mortality significantly decreased over the study period (ie, 2005 to 2018). This surveillance report provides trends and characteristics of unintentional carbon monoxide poisoning and the baseline morbidities and mortality data for the Centers for Disease Control and Prevention national surveillance system of carbon monoxide poisoning.

Screening patients for unintentional carbon monoxide exposure in the Emergency Department: a cross-sectional multi-centre study.

Low-level exposure to carbon monoxide (CO) is a significant health concern but is difficult to diagnose. This main study aim was to establish the prevalence of low-level CO poisoning in Emergency Department (ED) patients. A prospective cross-sectional study of patients with symptoms of CO exposure was conducted in four UK EDs between December 2018 and March 2020. Data on symptoms, a CO screening tool and carboxyhaemoglobin were collected. An investigation of participants' homes was undertaken to identify sources of CO exposure. Based on an ED assessment of 4175 participants, the prevalence of suspected CO exposure was 0.62% (95% CI; 0.41-0.91%). CO testing in homes confirmed 1 case of CO presence and 21 probable cases. Normal levels of carboxyhaemoglobin were found in 19 cases of probable exposure and in the confirmed case. This study provides evidence that ED patients with symptoms suggestive of CO poisoning but no history of CO exposure are at risk from CO poisoning. The findings suggest components of the CO screening tool may be an indicator of CO exposure over and above elevated COHb. Clinicians should have a high index of suspicion for CO exposure so that this important diagnosis is not missed.

Unintentional Carbon Monoxide Poisoning Outbreak from 2 to 9 October 2019 in Ulaanbaatar, Mongolia

Unintentional Carbon Monoxide Poisoning Outbreak from 2 to 9 October 2019 in Ulaanbaatar, Mongolia

Fatal unintentional non-fire related carbon monoxide poisoning: Data from Narrative Verdicts, England and Wales, 1998-2019

Background and Aim: Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning continues to cause fatalities. Coroners’ narrative verdicts concerning fatal UNFR CO poisoning in England and Wales, 1998-2019, were collated by the Office for National Statistics. Methods: Search terms related to CO exposure were used to obtain information regarding the circumstances of death. Findings were grouped by location of death, source of CO, and reason or behaviour underlying the exposure. Results: There were 750 deaths (77% male). Annual numbers of deaths decreased over the period studied. Two-thirds (68%) of the deaths occurred in the autumn/winter. Of records with information, 59% of deaths occurred in a dwelling (67% male). Males also predominated in deaths in vehicles (91%) and garages/outbuildings (95%). Of deaths with information, domestic piped gas was the most common source of CO (36%), and the most frequent underlying factor was inadequate ventilation of exhaust gases (39%, 91% male). Conclusion: Despite the decrease in the annual numbers of deaths over the study period, there remains a clear need for measures to raise awareness of the dangers of CO poisoning, especially amongst men working alone in garages/outhouses. Education campaigns and fitting and maintaining CO alarms in high-risk areas should be encouraged. Keywords: carbon monoxide, CO, unintentional poisoning, environmental epidemiology, environmental public health, unintentional death, preventing CO poisoning

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.

Trends in carbon monoxide poisoning deaths in high frequency hurricane states from 2014-19: the need for prevention intervention strategies.

Hurricanes often result in power outages, which increase generator usage and carbon monoxide (CO) deaths. We aim to identify states with the highest frequency of hurricanes and evaluate the number of unintentional CO poisoning deaths by region, age, race and metropolitan distribution. The number of hurricanes was determined using the FEMA database, and the number of unintentional CO poisoning deaths was determined using the CDC WONDER database from 2014-19. Hurricane-associated consumer outages were obtained from the Department of Energy. The number of unintentional CO poisoning deaths was as follows: Florida, South Carolina, North Carolina, Georgia and Alabama. Adults displayed a significantly higher number of unintentional CO poisoning deaths than pediatrics (P<0.001). The total number of unintentional CO poisoning deaths was highest in the White population (P<0.001); however, unintentional CO poisoning death rates were nearly two times higher among Black population in adults (0.5 versus 0.3) and pediatrics (0.2 versus 0.1). Medium metropolitan areas exhibited significantly more unintentional CO poisoning deaths (P<0.001). Hurricanes and unintentional CO poisoning deaths were most common in Florida. Death rates were higher among Black individuals. Medium metropolitan areas displayed significantly more unintentional CO poisoning deaths than all other areas.

Quantifying the Effects of Climate Factors on Carbon Monoxide Poisoning: A Retrospective Study in Taiwan.

Background: Carbon monoxide (CO) poisoning is the leading cause of poisoning death worldwide, but associations between CO poisoning and weather remain unclear.Objective: To quantify the influence of climate parameters (e.g., temperature, relative humidity, and wind speed) on the incidence risk of acute CO poisoning in Taiwan.Methods: We used negative binomial mixed models (NBMMs) to evaluate the influence of weather parameters on the incidence risk of acute CO poisoning. Subgroup analyses were conducted, based on the seasonality and the intentionality of acute CO poisoning cases.Results: We identified a total of 622 patients (mean age: 32.9 years old; female: 51%) with acute CO poisoning in the study hospital. Carbon monoxide poisoning was associated with temperature (beta: −0.0973, rate ratio (RR): 0.9073, p < 0.0001) but not with relative humidity (beta: 0.1290, RR: 1.1377, p = 0.0513) or wind speed (beta: −0.4195, RR: 0.6574, p = 0.0806). In the subgroup analyses, temperature was associated with the incidence of intentional CO poisoning (beta: 0.1076, RR: 1.1136, p = 0.0333) in spring and unintentional CO poisoning (beta: −0.1865, RR: 0.8299, p = 0.0184) in winter.Conclusion: Changes in temperature affect the incidence risk for acute CO poisoning, but the impact varies with different seasons and intentionality in Taiwan. Our findings quantify the effects of climate factors and provide fundamental evidence for healthcare providers to develop preventative strategies to reduce acute CO poisoning events.

Screening and management of unintentional low-level carbon monoxide exposure in the emergency department.

Unintentional carbon monoxide (CO) exposure, sometimes referred to as CO poisoning, is a serious threat to health and can have long-term effects on the neurological and respiratory systems. Patients who have been exposed can present to emergency departments (ED) with non-specific signs and symptoms, which makes it challenging to diagnose. This article describes the pathophysiology, signs and symptoms, and ED management of patients with possible or confirmed low-level CO exposure. It is important for emergency nurses to recognise patients with unintentional CO exposure so that treatment is provided and measures taken to prevent further exposure.

Carbon monoxide exposures reported to the UK National Poisons Information Service: a 4-year study.

Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS. We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses. 2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity. Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO.

Morbidity, and Mortality of Unintentional Carbon Monoxide Poisoning: United States 2005-2016

Background Carbon monoxide (CO) is a colorless, odorless, nonirritating gas that is produced through the incomplete combustion of carbon-containing substances. CO poisoning is a leading cause of unintentional poisoning deaths in the United States. The Centers for Disease Control and Prevention (CDC) routinely collects surveillance data from different sources to better understand unintentional CO exposures and identify potential environmental risk factors. Methods We used four different data sources to track unintentional CO-related exposures and CO poisoning: exposures called to poison control centers (PCCs), emergency department (ED) visits, hospitalizations, and mortality for 2005-2016. We conducted descriptive analyses by cause (fire, non-fire, unknown), month, age, region, and medical outcome (no effect, minor effect, moderate effect, major effect, and death). Results Over the 12-year study period, we observed 141,762 PCCS calls (national), 92,390 ED visits (16 states), 14,816 hospitalizations (25 states), and 12,478 deaths (national) due to unintentional CO poisoning. Non-fire unintentional cases comprised more than 70% of all hospitalizations and ED visits and 48% of all deaths compared to other unintentional cases. Across all data sources, CO exposures and poisonings were most commonly reported in January and December. Adults aged 50-59 years were the highest proportions for hospitalizations (19.7%) and deaths (17.0%). For PCC data, CO exposures were most frequently reported among children aged 0-9 years (21.1%) and in Northeastern states (&gt;70 per 100,000 population). Medical outcomes were most often reported as none or minor effect (n=146,067, 72.2%) in PCC data. Conclusions This surveillance report provides the most comprehensive review of unintentional CO poisonings in the US. Unintentional CO poisoning remains a public health concern. More standardized and continued public health surveillance of unintentional CO poisoning will be necessary to monitor the public health burden, identify novel exposure pathways, and assess the effectiveness of targeted prevention strategies.

Serum netrin-1 levels at presentation and delayed neurological sequelae in unintentional carbon monoxide poisoning

Objectives: The early identification of patients with a high risk of developing delayed neurological sequelae (DNS) can improve the quality of care in carbon monoxide (CO) poisoning cases. The aim of this study is to investigate whether the serum netrin-1 levels measured at presentation to the emergency department (ED) predicted the development of DNS after acute CO intoxication.Methods: This prospective observational study was conducted between 1 August 2018 and 31 July 2019 in a single tertiary hospital. The patients with acute CO intoxication and serum netrin-1 levels measured at the time of ED presentation were included in the study. All patients were followed up for six weeks regarding the development of DNS. The patients were divided into two groups, including those who developed DNS (DNS group) and those who did not (non-DNS group).Results: A total of 183 patients were included in the study, and 54 (29.5%) developed DNS. The median serum netrin-1 level at ED presentation was significantly lower in the DNS group (391.5 pg/mL [263.0–550.5]) than in the non-DNS group (626.0 pg/mL [505.9–755.6]) (p < .001). Multivariate analysis revealed that a low serum netrin-1 level (adjusted odds ratio [AOR]: 8.02, 95% CI: 2.45–26.20), low Glasgow coma scale (GCS) score at ED presentation (AOR: 0.81, 95% CI: 0.68–0.97), long CO exposure time (AOR: 1.96, 95% CI: 1.49–2.56), and the presence of acute brain lesions (AOR: 8.24, 95% CI: 2.37–28.58) on diffusion-weighted imaging were independent predictors of DNS. Serum netrin-1 levels less than 432 pg/mL predicted the development of DNS with a sensitivity of 68.5% (95% CI: 54.4%-80.5%) and a specificity of 86.0% (95% CI: 78.8%-91.5%).Conclusions: Low serum netrin-1 levels were significantly associated with the development of DNS. Therefore, serum netrin-1 at ED presentation can help identify patients at risk of developing DNS following discharge.

Beyond “Snow Shoveler's Infarction”: Broadening perspectives on winter health risks

AbstractWinter constitutes a significant threat to humans via damages, injuries, and fatalities in mid and high latitude environments. Much of the research into the health impacts of winter centers on urban areas in the snow climates of North America. When considering how humans are vulnerable to winter hazards, the legend of Snow‐Shoveler's Infarction dominates the public's assessment of winter health risks. This article seeks to broaden the understanding of winter hazards by summarizing the diversity of impacts on human health including frostbite, hypothermia, traffic accidents, slips, and falls, unintentional carbon monoxide poisoning in addition to injuries, and fatalities associated with snow removal. Further, social determinants such as poverty and social isolation are identified as being associated with negative health outcomes. The disproportionate health impacts of winter are also summarized, thus revealing how some groups, particularly the disadvantaged, the elderly and those with preexisting health issues in urbanized snow climates of the United States and Canada, are more vulnerable to winter hazards.

Carbon monoxide detector effectiveness in reducing poisoning, Wisconsin 2014–2016

Introduction: Carbon monoxide (CO) is a colorless, odorless, and nonirritating gas. The most common exposures are from gas powered appliances such as furnaces, water heaters, stoves, and vehicles. To prevent poisoning, CO detectors with audible alarms were developed. This study aims to evaluate the effectiveness of CO detectors in reducing poisoning in Wisconsin.Methods: Records were queried from National Poison Data System for unintentional CO exposures that occurred in residences in Wisconsin during 2014–2016 (N = 703). After applying sample exclusion criteria, notes were abstracted for cases where CO detector use was mentioned (n = 408). Logistic regression analyses were used to assess the association between having a CO detector alarm and CO poisoning. Linear regression analyses were used to assess the relationship between having a CO detector alarm and poisoning severity.Results: In logistic models, odds of CO poisoning were 3.2 times higher (95% CI: 1.5, 6.9) among those who had no CO detector compared to those who had a CO detector that alarmed. In linear models, not having a CO detector was associated with a 0.34 point (95% CI: 0.17, 0.54) change in outcome severity score compared to having a CO detector that alarmed.Discussion: Individuals who were exposed to CO in the absence of a CO detector were more likely to be poisoned and to have more severe medical outcomes than those that had a CO detector that alarmed.

Visualizing Carbon Monoxide Poisoning Surveillance Data on the US CDC National Environmental Public Health Tracking Network

TPS 683: Short-term health effects of air pollutants 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: CDC’s National Environmental Public Health Tracking Program (Tracking Program) aims to provide information from a nationwide network of integrated unintentional carbon monoxide (CO) poisoning data that could inform relevant public health action and prevention. Methods: The Tracking Program has developed dynamic environmental health surveillance system that includes standard visualization tools such as charts, interactive maps, and tables, and displays a variety of measures of morbidity and mortality (e.g., crude, and age-adjusted rates per 100,000) for unintentional CO poisoning. Users also can explore these measures by cause (i.e., fire, non-fire, unknown intent or mechanism). The hospitalization and emergency department (ED) data are obtained by the Tracking Program from funded state recipients (26 states); mortality data are from the National Vital Statistics System. We pooled the CO poisoning data from 2010-2014, and examined the proportion of unintentional non-fire CO poisonings, and compared state-specific age-adjusted rates during the same period. Results: During 2010-2014, there were more than 4,500 unintentional CO poisoning deaths with an average of 916 deaths annually. Deaths and hospitalizations categorized as non-fire comprised of 41.4%, and 55.4% of cases respectively. During the same period, states that had the two highest annual age-adjusted rate of ED visits for unintentional CO poisoning were Connecticut (AR: 21.4 in 2011) and Vermont (AR=15.7 in 2013), and the highest hospitalization rate were observed in New Mexico (AR: 2.1 in 2011) and Maryland (AR=1.8 in 2009). Conclusions: The Tracking Program demonstrates the opportunity to visualize environmental and health data on one data platform. This allows users to examine temporal and spatial trends and to identify communities at greater risk for CO poisoning. The Tracking Program’s CO poisoning data can be used to drive public health policy and actions that ultimately will reduce the burden of mortality and morbidity for CO poisoning.

Racial and ethnic trends in unintentional carbon monoxide poisoning deaths

Objective: Government programs have attempted to impact a recognized elevated risk for carbon monoxide (CO) poisoning among minority racial and ethnic groups. This study sought to describe U.S. mortality due to unintentional, non-fire-related CO poisoning, examining the distribution and trends by race and ethnicity. Methods: CDC Wonder was used to extract and analyze data on all U.S. resident deaths from unintentional CO poisoning from 2000-2017, categorizing them by year, race, ethnic origin and gender. Results: The absolute number of unintentional CO deaths decreased from about 450 to 380 per year during the period studied, a number near totally accounted for by the decrease in deaths occurring among non-Hispanic/ Latino whites. The number of deaths among the remainder of the population did not significantly change. However, greater growth in minority populations resulted in a similar decline in the mortality rate between non-Hispanic/ Latino whites and the combined minority population. The decline in combined minority death rate resulted from a decrease in the Hispanic/Latino white rate. Death rate did not decline in the black or African American population. Conclusions: All minority groups continue to display a disproportionate number of unintentional non-fire-related CO poisoning deaths compared to non-Hispanic/Latino whites. The decrease in U.S. deaths from unintentional non-fire-related carbon monoxide poisoning from 2000- 2017 is accounted for by a decrease in non-Hispanic/Latino white deaths. While numbers of such deaths among minority groups have not changed since 2000, increases in the size of minority populations have resulted in a declining crude death rate for Hispanic/Latino whites.

Unintentional carbon monoxide poisoning to the occupant of motor car by exhaust gases emitted by stranded traffic vehicles and the motor car itself

Incompletely burnt organic material is the major source of carbon monoxide in the environment. The hazardous nature of Carbon monoxide (CO) is mainly due to it being odourless, colourless, non-irritating, and tasteless and its omnipresent nature. It is also termed as a “silent killer” as it lacks the sensory warning properties. In the present case, a 30-year-old male was found dead in his car which was stuck in a pool of water along with many other vehicles stranded in a narrow lane following heavy rains. Autopsy features of CO poisoning were evident on examination. Chemical analysis report was positive for carboxyhemoglobin and alcohol. Fatal concentrations of CO gas are known to occur inside the automobile cabins due to defective exhaust systems. Alcohol impairs the reaction time and sensibility towards the signs of CO toxicity thereby reducing chances of survival. Awareness regarding dangers of CO poisoning, regular maintenance of vehicle and use of CO detectors are some of the key measures to avoid such fatalities. This case highlights the dangerous nature of carbon monoxide and fatal outcome of its exposure in an atmosphere with heavy concentration of exhaust gases and an enclosed space like a car in addition to the incapacitating effect of alcohol.

Unintentional Acute Carbon Monoxide Poisoning During Pregnancy: Five Years of Experience in Bordeaux

Unintentional Acute Carbon Monoxide Poisoning During Pregnancy: Five Years of Experience in Bordeaux

Severe unintentional first trimester carbon monoxide poisoning: case report

The fetus is uniquely susceptible to carbon monoxide (CO) exposure. We present a case of severe unintentional CO poisoning in the first trimester of pregnancy. A 23-year-old G5P2022 female at 11 weeks' gestational age sat in a car with the engine idling. She was unaware that the vehicle's exhaust pipe was blocked with snow. She was found to be unresponsive, with an initial carboxyhemoglobin (COHb) concentration of 47.1%. She underwent emergent treatment with hyperbaric oxygen therapy. The remainder of her pregnancy was complicated by a diagnosis of myasthenia gravis. She delivered a full-term infant who was noted to have persistently small head circumference. Fetal hemoglobin binds to CO more tightly than adult hemoglobin, and fetal carboxyhemoglobin concentrations are reported to exceed maternal levels. Fetal abnormalities may occur after CO poisoning in pregnancy and vary based on the gestational age of the fetus at the time of the exposure as well the chronicity of the exposure. Fetal survival after maternal CO exposure is possible even with significantly elevated maternal COHb concentrations, although teratogenic effects may occur depending on the timing of exposure.