Carbon Monoxide Toxicity

CARBON MONOXIDE TOXICITY......Page 2
Preface......Page 4
About the Editor......Page 5
Contributors......Page 6
Table of Contents......Page 9
Acknowledgment......Page 12
Dedication......Page 13
1.1 INTRODUCTION......Page 14
1.2 EXPERIENCE OF CARBON MONOXIDE POISONING WITHOUT KNOWLEDGE OF THE POISON......Page 16
1.3 DESCRIPTION OF CARBON MONOXIDE POISONING WITHOUT KNOWLEDGE OF THE MECHANISMS OF ACTION......Page 18
1.4.1 ASPECTS OF MECHANISMS OF CARBON MONOXIDE EFFECTS AND THERAPY......Page 19
1.4.2 TOXICOKINETICS AND CHEMICAL ANALYSIS......Page 20
1.4.3 TOXICODYNAMICS......Page 21
1.4.4 RECOMMENDATIONS FOR THRESHOLD LEVELS......Page 23
REFERENCES......Page 24
CONTENTS......Page 31
2.1 INTRODUCTION — HISTORICAL PERSPECTIVE......Page 32
2.2.1.1 Carbon Monoxide Formation from the Degradation of Heme......Page 34
2.2.1.1.1 Heme oxygenase......Page 35
2.2.1.1.2 Bilirubin......Page 37
2.2.1.2.1 Lipid Peroxidation......Page 38
2.2.1.2.2 Photo-oxidation......Page 39
2.2.2.1 Atmospheric Carbon Monoxide......Page 40
2.2.2.4.2 Anesthesia......Page 41
2.3.2 MYOGLOBIN AND OTHER HEMOPROTEINS......Page 42
2.4 CARBON MONOXIDE BODY STORES......Page 43
2.5.1 EXCRETION......Page 44
2.6 PHYSIOLOGICAL ROLE OF CARBON MONOXIDE......Page 45
2.7.1 SAMPLE COLLECTION AND STORAGE......Page 47
2.7.2.1.1 CO-oximetry......Page 48
2.7.2.1.2 Gas chromatography......Page 49
2.7.2.2 Carbon Monoxide in Extravascular Tissues......Page 50
2.7.2.3.1 Ambient air carbon monoxide concentrations......Page 52
2.7.2.3.3 Total-body carbon monoxide production measurements......Page 53
2.7.2.3.4 End-tidal carbon monoxide measurements......Page 55
2.7.2.3.5 In vitro carbon monoxide assays......Page 56
2.8 APPLICATIONS OF CARBON MONOXIDE-MEASURING TECHNOLOGY......Page 57
2.9 SUMMARY AND FUTURE DIRECTIONS......Page 58
REFERENCES......Page 59
3.1.2 EVOLUTION OF RESIDENTIAL CARBON MONOXIDE DETECTORS......Page 73
3.2 COMMON FEATURES OF RESIDENTIAL CARBON MONOXIDE DETECTORS......Page 76
3.3 SURVEY OF CARBON MONOXIDE SENSOR TECHNOLOGIES......Page 78
3.3.1 COLORIMETRIC SENSORS......Page 79
3.3.2 METAL OXIDE SEMICONDUCTOR SENSORS......Page 81
3.3.3 ELECTROCHEMICAL SENSORS......Page 83
3.3.4 INFRARED SENSORS......Page 86
3.3.5 COMPARISON OF SENSOR TECHNOLOGY......Page 87
3.4 OPERATING PRINCIPLES OF CARBON MONOXIDE DETECTORS......Page 88
REFERENCES......Page 93
CONTENTS......Page 95
4.2 LEGISLATIVE REQUIREMENTS FOR AIR QUALITY STANDARDS......Page 96
4.3 REGULATORY BACKGROUND FOR AIR QUALITY STANDARDS......Page 97
4.4.1 CARBOXYHEMOGLOBIN LEVELS OF CONCERN......Page 99
4.4.4 DECISION ON THE PRIMARY STANDARDS......Page 101
4.5.2 REGIONAL AND URBAN AMBIENT AIR QUALITY......Page 102
4.5.4 POPULATION EXPOSURE ASSESSMENT......Page 103
4.5.5 HEALTH EFFECTS......Page 104
4.6 IMPACT OF AIR QUALITY STANDARDS ON AMBIENT LEVELS OF CARBON MONOXIDE......Page 105
4.7 SUMMARY......Page 107
ABBREVIATIONS......Page 109
REFERENCES......Page 110
CONTENTS......Page 112
5.1 INTRODUCTION......Page 113
5.2.1 CARBOXYMYOGLOBIN......Page 114
5.2.2.2 Myocardium......Page 116
5.3.1.1 Cardiac Output......Page 118
5.3.1.2 Redistribution of Blood Flow......Page 121
5.3.1.3 Blood Pressure......Page 122
5.3.1.4 Peripheral Vascular Resistance......Page 123
5.3.1.6 Ventilation......Page 124
5.3.1.7 Thermoregulation......Page 125
5.3.2.2 O2 Uptake and Extraction......Page 126
5.3.3 OTHER FACTORS POTENTIALLY MODULATING THE RESPONSE......Page 128
5.4.1.1 Sea Level......Page 130
5.4.1.2 Altitude......Page 132
5.4.2.1 Blood Disorders and Respiratory Diseases......Page 134
5.4.2.2 Cardiovascular Diseases......Page 135
5.5 SUMMARY......Page 137
REFERENCES......Page 139
6.1 INTRODUCTION......Page 146
6.2 OXYGEN TRANSPORT......Page 148
6.3 EFFECTS OF ASCENT TO ALTITUDE......Page 149
6.5 CARBON MONOXIDE SOURCES AT ALTITUDE......Page 151
6.6 CARDIOVASCULAR EFFECTS OF CARBON MONOXIDE AT ALTITUDE......Page 154
6.7 VISION EFFECTS OF CARBON MONOXIDE AT ALTITUDE......Page 156
6.8 COMPARTMENT SHIFTS OF CARBON MONOXIDE AT ALTITUDE......Page 157
6.10 CARBOXYHEMOGLOBIN LEVELS AT ALTITUDE......Page 159
6.11.1 VOLUMETRIC MEASUREMENTS......Page 162
6.11.2 GRAVIMETRIC MEASUREMENTS......Page 163
ACKNOWLEDGMENTS......Page 164
REFERENCES......Page 165
CONTENTS......Page 168
7.1.1 GENERAL......Page 169
7.1.2 EFFECTS OF SPECIES DIFFERENCES......Page 171
1. Smoldering/Nonflaming Fires......Page 172
3. Ventilation-Controlled Flaming Fires......Page 173
7.1.4 CASE STUDIES......Page 174
7.2.1 GENERAL......Page 175
7.2.2.1 Hyperventilation......Page 176
7.2.2.2 Toxic Effects of Hypercapnia......Page 177
7.2.2.3 Effects of Carbon Dioxide on Low Oxygen Hypoxia......Page 178
7.2.2.4 Effect of Carbon Dioxide on Carbon Monoxide Toxicity......Page 179
7.2.2.6 Effects of Carbon Dioxide on Toxicity of Inhaled Irritants......Page 180
7.2.3.1 Toxicity of Hydrogen Cyanide......Page 181
7.2.3.2 Interactions between Carbon Monoxide and Cyanide......Page 183
7.2.4.1 Low Oxygen Hypoxia......Page 186
7.2.5 INTERACTIONS BETWEEN CARBON MONOXIDE AND INHALED IRRITANTS......Page 187
7.3.1 GENERAL......Page 189
7.3.2 PURSER HUMAN INCAPACITATION MODEL......Page 190
7.3.3 MODELS FOR PREDICTING LETHALITY LC50 CONCENTRATIONS IN RATS FOLLOWING A 30-MIN EXPOSURE......Page 194
7.3.3.1 Levin et al. N-Gas Model for Predicting FED for Lethality in Rats 30-min exposure + 14 days postexposure observation period......Page 196
7.3.3.2 Purser Model for Predicting FED for Lethality in Rats 30-min exposure + 14 days postexposure observation period......Page 197
7.4 CONCLUSIONS......Page 199
REFERENCES......Page 200
8.1 SIGNIFICANCE OF CARBON MONOXIDE POISONING IN THE UNITED STATES......Page 203
8.3 DEMOGRAPHICS OF INDIVIDUALS WITH CARBON MONOXIDE POISONING......Page 204
8.4 SOURCES OF CARBON MONOXIDE INVOLVED IN POISONINGS......Page 206
8.5 CIRCUMSTANCES OF CARBON MONOXIDE POISONING......Page 207
8.6 MANAGEMENT OF CARBON MONOXIDE POISONING IN THE UNITED STATES......Page 208
8.7 CONCLUSIONS......Page 212
REFERENCES......Page 213
9.1 INTRODUCTION......Page 216
9.2 BACKGROUND TO THE PROBLEM......Page 217
9.3.2 RESULTS......Page 222
9.3.4 PARASUICIDE......Page 227
9.4.2 PROFILE OF SUICIDE ATTEMPTERS BY CARBON MONOXIDE IN AN AUSTRALIAN POPULATION......Page 229
9.4.3 COMPARISON OF SUICIDE COMPLETERS AND SUICIDE ATTEMPTERS BY CARBON MONOXIDE POISONING......Page 232
9.4.4 FOLLOW-UP OF SURVIVORS OF ATTEMPTED SUICIDE BY EXPOSURE TO CAR EXHAUST......Page 233
9.5 DISCUSSION AND CONCLUDING REMARKS......Page 234
REFERENCES......Page 237
10.1 INTRODUCTION......Page 240
10.2.1 RECOGNITION AND DEFINITION OF NEURASTHENIA......Page 242
10.2.2 ETIOLOGIC THEORIES OF NEURASTHENIA......Page 248
10.2.3 OVERLAP WITH MULTIPLE CHEMICAL SENSITIVITY, CHRONIC FATIGUE SYNDROME, FIBROMYALGIA SYNDROME, AND GULF WAR SYNDROME......Page 250
10.3.1 HISTORY AND CHEMISTRY OF MANUFACTURED GAS......Page 252
10.3.2 SYMPTOMS OF CHRONIC CARBON MONOXIDE POISONING......Page 254
10.4 CARBON MONOXIDE AS A PUTATIVE CAUSE OF NEURASTHENIA ? EVANS’S 10 UNIFIED CRITERIA FOR DISEASE CAUSATION......Page 256
10.4.1 PREVALENCE CRITERIA......Page 257
10.4.2 EXPOSURE CRITERIA......Page 258
10.4.3 INCIDENCE CRITERIA......Page 259
10.4.6 MEASURABLE HOST RESPONSE CRITERIA......Page 260
10.4.10 MAKES-SENSE CRITERIA......Page 261
REFERENCES......Page 262
11.1 INTRODUCTION......Page 270
11.2 HISTORICAL PERSPECTIVE......Page 271
11.3 MECHANISMS OF CARBON MONOXIDE TOXICITY......Page 273
11.4.1 NORMOBARIC OXYGEN......Page 276
11.4.2 HYPERBARIC OXYGEN THERAPY......Page 277
11.4.3 ALLOPURINOL AND N-ACETYLCYSTEINE......Page 279
11.4.4 INSULIN......Page 280
11.4.5 NMDA RECEPTOR ANTAGONISTS......Page 281
11.4.6 BRAIN-DERIVED NEUROPEPTIDES......Page 282
11.5.1 GENERAL......Page 283
11.5.2 PREGNANCY......Page 285
11.6 MANAGEMENT OF THE SEQUELAE OF CARBON MONOXIDE POISONING......Page 287
REFERENCES......Page 288
CONTENTS......Page 299
12.2.1 THE LILLE POISON CENTRE SURVEILLANCE SYSTEM FOR CARBON MONOXIDE POISONING......Page 300
12.2.3 NONFATAL CARBON MONOXIDE POISONING......Page 302
12.2.4.2 Carbon Monoxide Poisoning Recurrence......Page 306
12.3.1.1 Effect on Oxygen Transport......Page 307
12.3.1.2.2 Effect on carbon monoxide binding to cytochrome a3......Page 308
12.3.3.1.2 Evidence for reoxygenation injury in carbon monoxide poisoning......Page 309
12.3.2 MANAGEMENT OF CARBON MONOXIDE POISONING......Page 310
12.3.3.1 Carbon Monoxide Poisoning and Pulmonary Edema......Page 311
12.3.3.3 Carbon Monoxide Poisoning and Pregnancy......Page 312
12.4 PREVENTION......Page 313
REFERENCES......Page 315
13.1 ACUTE CARBON MONOXIDE POISONINGS IN POLAND......Page 319
13.2 RESEARCH ON ACUTE CARBON MONOXIDE POISONING IN POLAND......Page 320
13.2.1 DURATION OF CARBON MONOXIDE EXPOSURE AND THE SEVERITY OF POISONING......Page 321
13.2.2 IN VIVO BINDING OF CARBON MONOXIDE TO MYOGLOBIN AT REST AND DURING INCREASED WORKLOAD......Page 325
13.3 DIAGNOSIS AND TREATMENT OF ACUTE CARBON MONOXIDE POISONING IN POLAND......Page 328
13.4 PREVENTION OF CARBON MONOXIDE POISONING......Page 333
REFERENCES......Page 334
14.1 CARBON MONOXIDE — FACTS AND PERCEPTIONS......Page 338
14.3 ESTABLISHMENT OF HYPERBARIC OXYGEN FACILITIES......Page 339
14.4 RECENT DEVELOPMENTS IN HYPERBARIC OXYGEN THERAPY......Page 340
14.5 COMMUNICATION: POISONS ADVICE SERVICES AND HYPERBARIC OXYGEN FACILITIES......Page 343
14.6 CURRENT ISSUES......Page 344
14.7 THE BRITISH HYPERBARIC ASSOCIATION: CONVERGENT STATEMENT......Page 345
14.8 ASSESSMENT......Page 346
14.9.2 HYPERBARIC OXYGEN ADMINISTRATION......Page 347
14.9.4 FOLLOW-UP......Page 348
REFERENCES......Page 349
15.1 CARBON MONOXIDE IN AMBIENT AIR IN CHINA’S MAJOR CITIES......Page 351
15.2 HEALTH EFFECTS OF AUTOMOBILE EXHAUST ON TRAFFIC POLICE......Page 355
15.3.1 METHODS OF HEATING......Page 357
15.3.2 TYPES OF RESIDENTIAL QUARTERS......Page 358
15.4 DERIVATION OF HYGIENIC STANDARDS FOR CARBON MONOXIDE IN AMBIENT AIR......Page 360
15.5 RELATED STUDIES......Page 364
REFERENCES......Page 366
16.1 INTRODUCTION......Page 368
16.2.1 BRAIN COMPUTED TOMOGRAPHY......Page 371
16.2.2 BRAIN MAGNETIC RESONANCE IMAGING......Page 375
16.2.3 BRAIN SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY......Page 379
REFERENCES......Page 382
17.1 INTRODUCTION......Page 386
17.2 RECENT EPIDEMIOLOGICAL STUDIES OF CARDIOVASCULAR MORBIDITY......Page 388
17.4 PLAUSIBILITY OF HEALTH EFFECTS RELATED TO LOW LEVELS OF CARBON MONOXIDE AT MONITORING STATIONS......Page 390
17.4.1 COMBINED EFFECTS OF CO AND TEMPERATURE......Page 391
17.6 LIMITATIONS OF TIME SERIES STUDIES......Page 393
17.7 CONCLUSIONS......Page 394
REFERENCES......Page 395
18.1.1 DEFINITIONS......Page 397
18.1.3 MISDIAGNOSIS......Page 399
18.1.4 R397397 ESIDUAL EFFECTS......Page 401
Hypothetical......Page 402
Actual......Page 403
18.2.2 OCCUPATIONAL STUDIES......Page 404
18.2.3 EPIDEMIOLOGICAL LARGE-SCALE STUDIES......Page 405
18.2.5 BECK CASE SERIES......Page 406
18.2.7 RYAN CASE REPORT......Page 408
18.2.8 MYERS ET AL. SHORT CASE SERIES STUDY......Page 409
18.3.1 CARBON MONOXIDE SUPPORT STUDY......Page 410
18.3.2 STUDY A — PENNEY......Page 412
18.3.3 STUDY B — PENNEY......Page 413
18.4 CONCLUSIONS......Page 418
ACKNOWLEDGMENT......Page 420
REFERENCES......Page 421
19.1 INTRODUCTION......Page 423
19.2.1 CONTROL SUBJECTS......Page 424
19.3.1 CHRONICALLY EXPOSED......Page 425
19.3.2 UNCONSCIOUS SUBJECTS......Page 429
19.3.3 FEATURES ABOUT THE EXPOSURE TO CARBON MONOXIDE......Page 432
19.3.4 INITIAL DIAGNOSIS......Page 434
19.3.5 ABILITY TO WORK, HOUSEHOLD INCOME, AND PAIN RELIEF......Page 437
19.4 DISCUSSION......Page 438
19.5 CONCLUSIONS......Page 440
REFERENCES......Page 441
20.1 INTRODUCTION......Page 442
20.2.1 INITIAL PRESENTATION......Page 443
20.3.1 REFERRAL......Page 444
20.3.2 CLINICAL NEUROPSYCHOLOGICAL INTERVIEW......Page 445
20.3.3 NEUROPSYCHOLOGICAL TESTING......Page 447
20.3.4 CLINICAL PSYCHOLOGICAL TESTING......Page 450
20.3.5 ASSESSING LEVEL OF EFFORT......Page 451
20.4.1 DSM-IV DIAGNOSES......Page 452
20.4.2 PSYCHOTHERAPY......Page 453
20.4.5 NEURO-OPHTHALMOLOGY/BEHAVIORAL OPTOMETRY......Page 454
20.5 CASE STUDY......Page 455
REFERENCES......Page 462
21.1 EPIDEMIOLOGY OF CARBON MONOXIDE POISONING IN CHILDREN......Page 465
21.2 SOURCES OF CARBON MONOXIDE EXPOSURE IN CHILDREN......Page 466
21.3 MECHANISMS OF CARBON MONOXIDE TOXICITY......Page 468
21.4 CLINICAL PRESENTATION......Page 471
21.5 FINDINGS AT PHYSICAL EXAMINATION......Page 473
21.6 OUTCOME......Page 474
21.8 ROLE OF CARBON MONOXIDE IN SUDDEN INFANT DEATH SYNDROME......Page 477
21.10.1 CARBOXYHEMOGLOBIN LEVELS......Page 478
21.10.3 ANCILLARY STUDIES......Page 479
21.10.4 NEUROIMAGING STUDIES......Page 480
21.11 TREATMENT......Page 481
21.13 PREVENTION......Page 484
REFERENCES......Page 485
22.1 INTRODUCTION......Page 494
22.2 CARBON MONOXIDE PRODUCTION......Page 496
22.2.1 SMOLDERING FIRES......Page 497
22.2.3 EQUIVALENCE RATIOS......Page 499
22.2.4 OVERVENTILATION AND UNDERVENTILATION......Page 500
22.2.5 HOW MUCH CARBON MONOXIDE WILL A FLAMING FIRE PRODUCE?......Page 501
22.3 CARBON MONOXIDE TRANSPORT IN FIRES......Page 503
22.4 THE REGULATORY RESPONSE TO CARBON MONOXIDE FROM FIRE......Page 507
22.4.2 CARBOXYHEMOGLOBIN HYPOTHESIS......Page 508
22.4.3 MULTIPLICATION OF UNCERTAINTIES......Page 510
22.5 SUMMARY AND CONCLUSIONS......Page 511
REFERENCES......Page 512
23.1 INTRODUCTION......Page 514
23.2.1 GAS FURNACES......Page 520
Case 981029......Page 521
Case 9402161......Page 522
Case 9808051......Page 523
23.2.3 GAS-FIRED OVENS/RANGES......Page 524
Case 9712101......Page 526
23.2.4 VEHICLES......Page 527
Case 9609291......Page 529
23.2.5 GAS-FIRED UNVENTED \0嘀䔀一吀ⴀ䘀刀䔀䔀 FIREPLACES......Page 530
Case 9711121......Page 532
23.2.6 NONSTATIONARY CARBON MONOXIDE SOURCES SMALL ENGINES, CHARCOAL GRILLS......Page 533
Case 981016......Page 534
23.3 INVESTIGATIVE TECHNIQUES FOR IDENTIFYING CARBON MONOXIDE SOURCES......Page 535
23.3.1 TESTS THAT SHOULD BE CONDUCTED......Page 538
23.4 PREVENTIVE STRATEGIES FOR REDUCING UNINTENTIONAL CARBON MONOXIDE POISONING......Page 539
REFERENCES......Page 540