Carbon Monoxide Poisoning Author: Jeffrey T. Chapman, MD
Editorial changes - 2009-10-30
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
References
Glossary
What's New
Patient Information
Additional Resources
Tools
References
1. 2Yoon SS, Macdonald SC, Parrish RG. Deaths from unintentional carbon monoxide poisoning and potential for prevention with carbon monoxide detectors. JAMA. 1998;279:685-7. (PMID: 9496987)
2. 2Clifton JC 2nd, Leikin JB, Hryhorczuk DO, Krenzelok EP. Surveillance for carbon monoxide poisoning using a national media clipping service. Am J Emerg Med. 2001;19:106-8. (PMID: 11239251)
3. 2Girman JR, Chang YL, Hayward SB, Liu KS. Causes of unintentional deaths from carbon monoxide poisonings in California. West J Med. 1998;168:158-65. (PMID: 9549414)
4. 2Hawkes AP, McCammon JB, Hoffman RE. Indoor use of concrete saws and other gas-powered equipment. Analysis of reported carbon monoxide poisoning cases in Colorado. J Occup Environ Med. 1998;40:49-54. (PMID: 9467120)
5. 1Pelham TW, Holt LE, Moss MA. Exposure to carbon monoxide and nitrogen dioxide in enclosed ice arenas. Occup Environ Med. 2002;59:224-33. (PMID: 11934949)
6. 2Ely EW, Moorehead B, Haponik EF. Warehouse workers' headache: emergency evaluation and management of 30 patients with carbon monoxide poisoning. Am J Med. 1995;98:145-55. (PMID: 7847431)
7. 2Silvers SM, Hampson NB. Carbon monoxide poisoning among recreational boaters. JAMA. 1995;274:1614-6. (PMID: 7474247)
8. 3Zelnick SD, Lischak MW, Young DG 3rd, Massa TV. Prevention of carbon monoxide exposure in general and recreational aviation. Aviat Space Environ Med. 2002;73:812-6. (PMID: 12182223)
9. 2Houck PM, Hampson NB. Epidemic carbon monoxide poisoning following a winter storm. J Emerg Med. 1997;15:469-73. (PMID: 9279697)
10. 2Wrenn K, Conners GP. Carbon monoxide poisoning during ice storms: a tale of two cities. J Emerg Med. 1997;15:465-7. (PMID: 9279696)
11. 2Wilson RC, Saunders PJ, Smith G. An epidemiological study of acute carbon monoxide poisoning in the West Midlands. Occup Environ Med. 1998;55:723-8. (PMID: 9924447)
12. 2Dolan MC, Haltom TL, Barrows GH, Short CS, Ferriell KM. Carboxyhemoglobin levels in patients with flu-like symptoms. Ann Emerg Med. 1987;16:782-6. (PMID: 3592333)
13. 2Turnbull TL, Hart RG, Strange GR, Cooper MA, Lindblad R, Watkins JM, et al. Emergency department screening for unsuspected carbon monoxide exposure. Ann Emerg Med. 1988;17:478-83. (PMID: 3364828)
14. 2Heckerling PS, Leikin JB, Maturen A, Terzian CG, Segarra DP. Screening hospital admissions from the emergency department for occult carbon monoxide poisoning. Am J Emerg Med. 1990;8:301-4. (PMID: 2094235)
15. 2Jaslow D, Ufberg J, Ukasik J, Sananman P. Routine carbon monoxide screening by emergency medical technicians. Acad Emerg Med. 2001;8:288-91. (PMID: 11229955)
16. 3Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339:1603-8. (PMID: 9828249)
17. 3Fisher J. Carbon monoxide poisoning: a disease of a thousand faces [Editorial]. Chest. 1999;115:322-3. (PMID: 10027426)
18. 3Abelsohn A, Sanborn MD, Jessiman BJ, Weir E. Identifying and managing adverse environmental health effects: 6. Carbon monoxide poisoning. CMAJ. 2002;166:1685-90. (PMID: 12126326)
19. 3Jaffe FA. Pathogenicity of carbon monoxide. Am J Forensic Med Pathol. 1997;18:406-10. (PMID: 9430296)
20. 2Heckerling PS, Leikin JB, Maturen A, Perkins JT. Predictors of occult carbon monoxide poisoning in patients with headache and dizziness. Ann Intern Med. 1987;107:174-6. (PMID: 3605895)
21. 2Gorman DF, Clayton D, Gilligan JE, Webb RK. A longitudinal study of 100 consecutive admissions for carbon monoxide poisoning to the Royal Adelaide Hospital. Anaesth Intensive Care. 1992;20:311-6. (PMID: 1524170)
22. 2Kelley JS, Sophocleus GJ. Retinal hemorrhages in subacute carbon monoxide poisoning. Exposures in homes with blocked furnace flues. JAMA. 1978;239:1515-7. (PMID: 633561)
23. 2Amitai Y, Zlotogorski Z, Golan-Katzav V, Wexler A, Gross D. Neuropsychological impairment from acute low-level exposure to carbon monoxide. Arch Neurol. 1998;55:845-8. (PMID: 9626776)
24. 2Dean BS, Verdile VP, Krenzelok EP. Coma reversal with cerebral dysfunction recovery after repetitive hyperbaric oxygen therapy for severe carbon monoxide poisoning. Am J Emerg Med. 1993;11:616-8. (PMID: 8043054)
25. 3Hartman DE. Missed diagnoses and misdiagnoses of environmental toxicant exposure. The psychiatry of toxic exposure and multiple chemical sensitivity. Psychiatr Clin North Am. 1998;21:659-70, vii. (PMID: 9774803)
26. 2Marius-Nunez AL. Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide. Chest. 1990;97:491-4. (PMID: 2298080)
27. 2Chou KJ, Fisher JL, Silver EJ. Characteristics and outcome of children with carbon monoxide poisoning with and without smoke exposure referred for hyperbaric oxygen therapy. Pediatr Emerg Care. 2000;16:151-5. (PMID: 10888449)
28. 2Hampson NB. Pulse oximetry in severe carbon monoxide poisoning. Chest. 1998;114:1036-41. (PMID: 9792574)
29. 2Touger M, Gallagher EJ, Tyrell J. Relationship between venous and arterial carboxyhemoglobin levels in patients with suspected carbon monoxide poisoning. Ann Emerg Med. 1995;25:481-3. (PMID: 7710152)
30. 2Wald N, Idle M, Bailey A. Carboxyhaemoglobin levels and inhaling habits in cigarette smokers. Thorax. 1978;33:201-6. (PMID: 663879)
31. 2Norkool DM, Kirkpatrick JN. Treatment of acute carbon monoxide poisoning with hyperbaric oxygen: a review of 115 cases. Ann Emerg Med. 1985;14:1168-71. (PMID: 4061988)
32. 2Lapostolle F, Raynaud PJ, Le Toumelin P, Benaissa A, Agostinucci JM, Adnet F, et al. [Measurement of carbon monoxide in expired breath in prehospital management of carbon monoxide intoxication]. Ann Fr Anesth Reanim. 2001;20:10-5. (PMID: 11234571)
33. 2Wickramatillake HD. Validation of the end-expired method for measuring carboxyhaemoglobin levels for the use in occupational and environmental exposure studies. Occup Med (Lond). 1999;49:43-5. (PMID: 10451586)
34. 2Wallace W. The use of exhaled carbon monoxide for the diagnosis of carbon monoxide poisoning. A case report. Alaska Med. 1998;40:33-5. (PMID: 9658657)
35. 2Jones JS, Lagasse J, Zimmerman G. Computed tomographic findings after acute carbon monoxide poisoning. Am J Emerg Med. 1994;12:448-51. (PMID: 8031431)
36. 2Kanaya N, Imaizumi H, Nakayama M, Nagai H, Yamaya K, Namiki A. The utility of MRI in acute stage of carbon monoxide poisoning. Intensive Care Med. 1992;18:371-2. (PMID: 1469165)
37. 2Pracyk JB, Stolp BW, Fife CE, Gray L, Piantadosi CA. Brain computerized tomography after hyperbaric oxygen therapy for carbon monoxide poisoning. Undersea Hyperb Med. 1995;22:1-7. (PMID: 7742705)
38. 3Myers RA, DeFazio A, Kelly MP. Chronic carbon monoxide exposure: a clinical syndrome detected by neuropsychological tests. J Clin Psychol. 1998;54:555-67. (PMID: 9696105)
39. 2Rottman SJ, Kaser-Boyd N, Cannis T, Alexander J. Low-level carbon-monoxide poisoning: inability of neuropsychological testing to identify patients who benefit from hyperbaric oxygen therapy. Prehospital Disaster Med. 1995;10:276-82. (PMID: 10155442)
40. 2Turner M, Esaw M, Clark RJ. Carbon monoxide poisoning treated with hyperbaric oxygen: metabolic acidosis as a predictor of treatment requirements. J Accid Emerg Med. 1999;16:96-8. (PMID: 10191440)
41. 2Hampson NB, Dunford RG, Kramer CC, Norkool DM. Selection criteria utilized for hyperbaric oxygen treatment of carbon monoxide poisoning. J Emerg Med. 1995;13:227-31. (PMID: 7775795)
42. 2Annane D, Chevret S, Jars-Guincestre C, Chillet P, Elkharrat D, Gajdos P, et al. Prognostic factors in unintentional mild carbon monoxide poisoning. Intensive Care Med. 2001;27:1776-81. (PMID: 11810122)
43. 2Weaver LK, Howe S, Hopkins R, Chan KJ. Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100% oxygen at atmospheric pressure. Chest. 2000;117:801-8. (PMID: 10713010)
44. 1Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002;347:1057-67. (PMID: 12362006)
45. 1Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med. 1995;25:474-80. (PMID: 7710151)
46. 1Scheinkestel CD, Bailey M, Myles PS, Jones K, Cooper DJ, Millar IL, et al. Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial. Med J Aust. 1999;170:203-10. (PMID: 10092916)
47. 1Raphael JC, Elkharrat D, Jars-Guincestre MC, Chastang C, Chasles V, Vercken JB, et al. Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication. Lancet. 1989;2:414-9. (PMID: 2569600)
48. 2Hampson NB, Simonson SG, Kramer CC, Piantadosi CA. Central nervous system oxygen toxicity during hyperbaric treatment of patients with carbon monoxide poisoning. Undersea Hyperb Med. 1996;23:215-9. (PMID: 8989851)
49. 2Deschamps D, Géraud C, Julien H, Baud FJ, Dally S. Memory one month after acute carbon monoxide intoxication: a prospective study. Occup Environ Med. 2003;60:212-6. (PMID: 12598670)
50. 2Choi IS. Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol. 1983;40:433-5. (PMID: 6860181)
51. 2Lee MS, Marsden CD. Neurological sequelae following carbon monoxide poisoning clinical course and outcome according to the clinical types and brain computed tomography scan findings. Mov Disord. 1994;9:550-8. (PMID: 7990850)
52. 3Hopkins RO. Neurocognitive and affective sequelae of carbon monoxide poisoning. In: Penney DG, ed. Carbon Monoxide Poisoning. Boca Raton, FL: CRC Press; 2008:477-94.
53. 2Sawada Y, Takahashi M, Ohashi N, Fusamoto H, Maemura K, Kobayashi H, et al. Computerised tomography as an indication of long-term outcome after acute carbon monoxide poisoning. Lancet. 1980;1:783-4. (PMID: 6102675)
New References of Interest
54. Leikin JB, Wills BK. Long-term psychiatric consequences from carbon monoxide exposure: progression of endogenous cause or toxicant effect? Crit Care Med. 2009;37:2116-8. (PMID: 19448463)
55. Hampson NB, Rudd RA, Hauff NM. Increased long-term mortality among survivors of acute carbon monoxide poisoning. Crit Care Med. 2009;37:1941-7. (PMID: 19384195)
FAQs
Jeffrey T. Chapman, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP. Because all PIER modules are updated regularly, printed web pages or PDFs may rapidly become obsolete. Therefore, PIER users should compare the date of the last update on the website with any printout to ensure that the information being referred to is the most current available.
PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.