Journal article
Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy
American journal of respiratory and critical care medicine, Vol.195(5), pp.596-606
03/01/2017
DOI: 10.1164/rccm.201606-1275CI
PMCID: PMC5363978
PMID: 27753502
Abstract
Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1 to 3%. A significant number of patients who survive CO poisoning suffer from long-term neurological and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation, and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15-40% of patients, whereas approximately one-third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction, and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed posthypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. Although hyperbaric oxygen significantly reduces the permanent neurological and affective effects of CO poisoning, a portion of survivors still have substantial morbidity. There has been some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development.
Details
- Title: Subtitle
- Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy
- Creators
- Jason J. Rose - National Heart Lung and Blood InstituteLing Wang - National Heart Lung and Blood InstituteQinzi Xu - National Heart Lung and Blood InstituteCharles F. McTiernan - National Heart Lung and Blood InstituteSruti Shiva - University of PittsburghJesus Tejero - National Heart Lung and Blood InstituteMark T. Gladwin - National Heart Lung and Blood Institute
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.195(5), pp.596-606
- Publisher
- Amer Thoracic Soc
- DOI
- 10.1164/rccm.201606-1275CI
- PMID
- 27753502
- PMCID
- PMC5363978
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Number of pages
- 11
- Grant note
- F32HL132418 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 03/01/2017
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304682602771
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