Carbon Monoxide Poisoning

Joseph Varon; Paul E Marik

摘要

Address for correspondence:Joseph Varon, M.D., F.A.C.P., F.C.C.P. Assistant Professor, Anesthesiology, Critical Care and MedicineThe University of Texas M.D. Anderson Cancer Center1515 Holcombe Boulevard, Box 042Houston, TX 77030TeL: (713)745-1771Fax: (713)794-4590e-mail: varon@surg.mdacc.tmc.edu;I. Introduction Carbon monoxide (CO) is a colorless, odorless, toxic gas that is a product of incomplete combustion. Motor vehicles, heaters, appliances that use carbon based fuels, and household fires are the main sources of this poison. Carbon monoxide (CO) intoxication is the leading cause of death due to poisoning in the United States.1,2,3,4,5. CO poisoning is also the most common cause of death in combustion related inhalation injury.6,7 The incidence of non-lethal CO poisoning is not well established nor is that of unrecognized CO poisoning (subacute poisoning due to an unrecognized toxic CO exposure in the home or other indoor environment).8;II. Epidemiology CO poisoning has been recognized for many centuries, soon after our ancestors attempted to build fires in non-ventilated shelters. The first accurate description of CO poisoning was recorded by Claude Bernard in 1857. Since then many advances in our understanding of the pathophysiology have been achieved.The true incidence of CO poisoning is not known, since many non-lethal exposures go undetected.7 It has been estimated that one-third of all cases of CO poisoning are undiagnosed. This year 10,000 persons will seek medical attention or will miss at least one day of normal activity due to CO poisoning.9 Mortality rates as high as 31% have been reported in large series, though in other surveys it has been only 1-2%.7 Nevertheless, from 1979 through 1988, unintentional deaths from CO poisoning in the United States have declined consistently.1The most common sources for CO are listed below. CO from motor-vehicle exhausts is the single most common cause of poisoning deaths in the United.10 Of the 11 547 unintentional CO deaths during 1979-1988, 57% were caused by motor vehicle exhausts; of these 83% were associated with stationary vehicles.10 Most motor-vehicle-related CO deaths in garages have occurred even though the garage doors or windows have been open, suggesting that passive ventilation may not be adequate to reduce risk in semi-closed spaces. Smoke inhalation from all types of fires is the second leading cause of CO poisoning. Most immediate deaths from building fires are due to CO poisoning and therefore, fire fighters are at high risk.Exogenous Sources of COEpidemics of CO poisoning commonly occur during winter months and sources include misuse of non-electric heating or cooking devices as well as snow-obstructed motor vehicle exhaust systems. These epidemics are particularly common during winter storms due to power outages with the use of alternative methods of heating and cooking. 11,12 It is well known that urban environments contain higher ambient CO concentrations, primarily due to automotive emissions, and non-smoking city dwellers have been found to have carboxyhemoglobin (COHb) levels in the 1-2% range.13 Tobacco smoke is also a significant source of CO, containing approximately 4% CO; smokers have been observed to have COHb levels typically in the 4-5% range and as high as 9%. Hence, their COHb levels must be interpreted accordingly.Methylene chloride (MC) deserves a special mention because it is contained in many paint removers and its vapors are readily absorbed through the lungs. Once it reaches the circulation, MC is converted into CO in the liver.14;III. Pathophysiology In patients who die early following CO poisoning the brain is edematous, and there are diffuse petechia and hemorrhages. If the victim survives initially but dies within a few weeks, findings typical of ischemic anoxia are prominent. The pathologic findings is human victims have been reproduced in experimental animals poisoned with CO. Interestingly, the severity of the lesions appears to

机译：通讯地址：约瑟夫·瓦伦（Joseph Varon），医学博士，足球俱乐部，足球俱乐部麻醉学，重症监护和医学助理教授德克萨斯大学MD安德森癌症中心1515 Holcombe Boulevard，Box 042休斯敦，TX 77030电话：(713)745-1771传真：(713)794-4590电子邮件：varon@surg.mdacc.tmc.edu ;一世。简介一氧化碳（CO）是无色，无味，有毒气体，是不完全燃烧的产物。机动车，取暖器，使用碳基燃料的电器和家庭火灾是该毒物的主要来源。一氧化碳（CO）中毒是美国中毒导致死亡的主要原因。1,2,3,4,5。一氧化碳中毒也是与燃烧有关的吸入伤害中最常见的死亡原因。6,7尚未确定非致命性一氧化碳中毒的发生率，也未确定未被识别的一氧化碳中毒的发生率（亚急性中毒是由于未认识到的一氧化碳中毒导致的。家庭或其他室内环境）.8; II。在我们的祖先试图在不通风的庇护所中起火之后不久，流行病学就已经认识到CO中毒。 1857年，克劳德·伯纳德（Claude Bernard）记录了对CO中毒的第一个准确描述。从那时起，我们对病理生理学的理解取得了许多进展。由于许多非致命性接触未被发现，因此CO中毒的真正发病率尚不清楚。7据估计，在所有的CO中毒病例中，有三分之一是未被诊断的。今年，有10,000人将因一氧化碳中毒而寻求医疗救治或至少失去一天的正常活动。9大量报道的死亡率高达31％，而在其他调查中，这一数字仅为1-2％。 .7尽管如此，从1979年到1988年，美国因CO中毒造成的意外死亡人数持续下降。1下面列出了最常见的CO来源。机动车尾气中的一氧化碳是导致美国中毒死亡的最常见原因。10在1979-1988年间的11 547起无意中的一氧化碳死亡中，有57％是由机动车尾气引起的。在这83％的人中，有9％与固定车辆有关。10即使车库门或窗户打开，大多数与汽车相关的CO死亡均已发生，这表明被动通风可能不足以降低半封闭空间的风险。各种火灾引起的烟雾吸入是一氧化碳中毒的第二大原因。建筑物火灾最直接造成的死亡是由于CO中毒造成的，因此，消防员处于高风险中。COE的外源性CO中毒的流行病通常发生在冬季，其来源包括滥用非电加热或烹饪设备以及下雪。阻碍了汽车的排气系统。这些流行病在冬季暴风雨中由于停电以及使用其他加热和烹饪方法而特别普遍。 11,12众所周知，主要由于汽车排放，城市环境中的环境CO浓度较高，非吸烟城市居民的羧基血红蛋白（COHb）水平在1-2％的范围内。13也是重要的一氧化碳来源，含有约4％的二氧化碳;吸烟者的COHb水平通常在4-5％范围内，最高可达9％。因此，必须对它们的COHb水平进行相应的解释。值得一提的是二氯甲烷（MC），因为它包含在许多脱漆剂中，并且其蒸气很容易通过肺吸收。一旦到达循环，MC就会在肝脏中转化为CO。14; III。病理生理学在CO中毒后死亡的患者中，脑水肿，并有弥漫性瘀斑和出血。如果受害人最初存活下来，但在几周内死亡，则典型的缺血性缺氧发现很明显。病理结果是人类受害者已在被CO中毒的实验动物中繁殖。有趣的是，病变的严重程度似乎

Carbon Monoxide Poisoning

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