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Carbon Monoxide Poisoning

Gambit News: "Unseen Menace: Carbon Monoxide Poisoning"

Carbon monoxide is a gas byproduct from the incomplete combustion of fossil fuels. Common sources of acute and often lethal carbon monoxide poisoning include generators whose fumes to enter a house; kerosene heaters being used indoors; charcoal being burned inside a house; and cars left running in a garage, even with the door open.
Exposure to the toxic gas is less obvious when a gas heater or stove is not working properly, or when a fuel-burning appliance is not burning clean. In those cases, enough carbon monoxide can leak to cause chronic poisoning, but not severe, acute poisoning.

Controversies in the treatment of acute carbon monoxide intoxication

Acute carbon monoxide (CO) poisoning causes brain lipid peroxidation as well as an hypoxic injury. Traditional therapy has been 1 ATA oxygen but now includes hyperbaric oxygen therapy (HBOT) which hastens dissociation of COHgb, reverses anoxia, inhibits reperfusion injury, and has toxic effects. All of these are dose dependant and time sensitive. The human experience with HBOT is anecdotal cases, uncontrolled and controlled series, which are largely positive, and randomized, prospective e controlled studies with conflicting results. A controversy exists over the pressure and number of HBOTs.

HMPAO SPECT Brain Imaging of Acute CO Poisoning and Delayed Neuropsychological Sequelae (DNSS)

PG Harch, KW Van Meter, SF Gottlieb, P Staab. JoEllen Smith Hyperbaric Medicine Unit, New Orleans, LA 70131

Background: Brain CT and MRI are poor barometers of acute CI poisoning and the DNSS syndrome, registering abnormalities in a minority of patients. HMPAO SPECT, a flow metabolism modality, seems more appropriate. We report 12 cases of acute poisoning and DNSS imaged with HMPAO SPECT/

Hyperbaric Oxygen Therapy Treatment of Neurological Residual of Carbon Monoxide Poisoning

Paul G. Harch, Keith Van Meter, Paul K Staab, Sheldon F. Gottlieb, Jo Ellen Smith Medical Center, New Orleans, LA.

There is no accepted treatment for neurological residual of carbon monoxide poisoning; this report documents the effect of HBOT for established neurological residual.