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EDUCATION LEVEL IS GREATEST RISK-FACTOR IN CARBON MONOXIDE POISONING
Citation:
Petersen*, D AND D. Kob. EDUCATION LEVEL IS GREATEST RISK-FACTOR IN CARBON MONOXIDE POISONING. Presented at Society of Toxicology, Salt Lake City, UT, 3/10/2003.
Description:
Carbon monoxide (CO) is a toxic by-product of the combustion of fossil fuels. In confined spaces, inefficient combustion sources, such as furnaces, stoves, kerosene heaters and automobiles can generate levels of CO that interrupt oxygen transport throughout the body, potentially resulting in death. CO interferes with oxygen transport primarily by avidly binding to the oxygen carrying pigment hemoglobin, rendering it incapable of its normal function of oxygen delivery to the tissues. CO also binds other iron-containing heme proteins like the cytochrome respiratory pigments in mitochondria, but these are secondary effects in the pathophysiology of CO.
Emergency treatment for moderate to severely poisoned patients is primarily achieved through the use of hyperbaric oxygen treatment. At high pressure, sufficient oxygen dissolves in the blood plasma to provide oxygen to the tissues, making the poisoned hemoglobin irrelevant. During hyperbaric oxygen treatment, CO also dissociates from poisoned hemoglobin (carboxyhemoglobin) with a shorter half-time, leading to complete detoxification.
In order to better prevent CO toxicity, we sought to understand the causal factors predisposing individuals to CO poisoning. We thus undertook a review of medical records from the Center for Hyperbaric Medicine in the University of Cincinnati?s Department of Emergency Medicine. We analyzed the records of patients by home address, age, gender, CO source, ethnicity, date of poisoning and educational status.
We found that educational status was the strongest predictor of potential for CO poisoning. There was approximately a 50-fold difference in the poisoning rates between those with less than a grade-school education and those having a college degree. Clearly, education is a primary tool for the prevention of CO poisoning. These data illuminate the potential problem that the highest risk subpopulation is likely to have literacy problems, and may not be amenable to traditional public health education efforts.