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CARBON MONOXIDE POISONING--A PUBLIC HEALTH PERSPECTIVE.
Raub, J. A., M. Mathieu-Nolf, N. B. Hampson, AND S. R. Thom. CARBON MONOXIDE POISONING--A PUBLIC HEALTH PERSPECTIVE. TOXICOLOGY. Elsevier Science Ltd, New York, NY, 145(1):1-14, (2000).
Carbon monoxide (CO) may be the cause of more than one-half of the fatal poisonings reported in many countries: fatal cases also are grossly under-reported or mis-diagnosed by medical professionals. Therefore, the precise number of individuals who have suffered from CO intoxication is not known. The health effects associated with exposure to CO range from the more subtle cardiovascular and neuro-behavioral effects at low concentrations to unconsciousness and death after acute or chronic exposure to higher concentrations of CO. The morbidity and mortality resulting from the latter exposures are described briefly to complete the picture of CO exposure in present-day society. The symptoms, signs, and prognosis of acute CO poisoning correlate poorly with the level of carboxyhemoglobin (COHb) measured at the time of hospital admission; however, because CP poisoning is a diagnosis frequently overlooked, the importance of measuring COHb in suspicious settings cannot be overstated. The early symptoms (headache, dizziness, weakness, nausea, confusion, disorientation, and visual disturbances) also have to be emphasized, especially if they recur with a regular periodicity or in the same environment. Complications occur frequently in CO poisoning. Immediate death is most likely cardiac in origin because myocardial tissues are most sensitive to the hypoxic effects of CO. Severe poisoning results in marked hy-otension, lethal arrhythmias, and electrocardiographic changes. Pulmonary edema may occur. Neurological manifestation of acute CO poisoning includes disorientation, confusion, and coma. Perhaps the most insidious effect of CP poisoning is the development of delayed neuropsychiatric impairment within 2 - 28 days after poisoning and the slow resolution of neurobehavioral consequences. Carbon monoxide poisoning during pregnancy results in high risk for the mother by increasing the short-term complication rate anf for the fetus by causing fetal death, developmental disorders, and chronic cerebral lesions. In conclusion. CO poisoning occurs frequently; has severe consequences, including immediate death; involves complications and late sequelae; and often is overlooked. Efforts in prevention and in public and medical education should be encouraged.