Health affects of carbon monoxide poisoning

As professionals in the field we come into many households and commercial buildings containing people with medical problems. This includes households with elderly or anyone with heart disease, pregnant women and their fetus, infants, children and adults with asthma, or perhaps anyone of any age experiencing temporary poor health like the flue, colds, seasonal allergies and others.

We have the opportunity to diagnose and/or eliminate this poison which may be contributing to someone’s poor health condition.  Let’s examine how carbon monoxide poisons us.

When carbon monoxide is inhaled into the lungs and bonds with hemoglobin in blood, which forms Carboxyhemoglobin (COHb).  This condition displaces oxygen in the blood stream and affects all major organs and muscles.

It has been determined that carbon monoxide molecules bond with hemoglobin in blood over 200 times more easily than oxygen molecules. Suffocation occurs from the inside out.

The health effects of CO depend upon the concentration in the air and the duration of the exposure.  Extended exposure to high concentrations will lead to unconsciousness, brain damage or death.  However, for those of more vulnerable health, a lower concentration of exposure for longer periods of time may have similar effects as high concentrations for brief periods.

 Healthy adults may show no ill effects to low concentrations of carbon monoxide.  However, headaches, a constant stuffiness or head pressure are very common symptoms of early CO poisoning and may be the prelude of a worsening condition.  These conditions can go undiagnosed.

Respiratory problems, chronic heart disease, dizziness, vomiting, confusion, general weakness of the body or flu-like symptoms may be a result of CO poisoning.  

Recent medical studies attempting to further understand low level CO poisoning have found blood vessels are a major site of damage in the brain, especially the cells that line the inner wall of the vessels, called the endothelium.  This damage occurs relatively early during exposure to CO.  Additional studies suggest this could be happening with lower concentrations of CO over longer periods of time.

These recent studies also suggest carbon monoxide molecules in human blood also readily attach themselves to the same proteins Nitric oxide (NO) do.  NO is a much studied, naturally occurring vasodilator (widens blood vessels) and gaseous signaling molecule.  An excess of NO, however, is harmful to brain cells and other tissues.

This imbalance makes NO available for biochemical reactions that would not normally occur within the cell, namely ones that produce tissue-damaging oxidants and free radicals. 

Research shows more NO being released by cells with exposure to greater and greater concentrations of CO. The cells eventually died.  Lower doses of CO result in less cell death but cell death none-the-less.

Hopefully, the end result of CO and human impact studies will result in improved general understanding of CO exposure and a more aggressive and preventative treatment.

In the field, simple observations or findings may alert you to a potentially dangerous condition.  As an example, the occurrence of illness in household pets concurrent with or just preceding the onset of a patient’s own illness should alert to the possibility of CO poisoning.

 Due to their smaller size and generally higher metabolic rate, pets may be more obviously and more severely affected by CO intoxication than their owners.

Arterial blood sampling has been demonstrated to be the most traditional and accurate way of determining COHb %.  It is painful, expensive and not readily available for field use.  General practitioners and others in the health profession do not routinely draw blood samples from every patient showing symptoms that can now be associated to CO poisoning of some degree or another. 

The most common misdiagnosis of CO poisoning is a “flu-like” syndrome.  Additional misdiagnosis includes food poisoning, depression, coronary artery disease, arrhythmia and functional illnesses among others.  Blood sampling for CO in the field is not practical.  However, breath analysis for CO with a Bacharach BAM unit is.

While a University of Pittsburgh study validated the accuracy of determining COHb levels in the blood utilizing the Breath Analysis Module, several professionals in the field are uncomfortable with this direct correlation.

Further research is being conducted, but the bottom line is that if testing a healthy, non-smoker finds a significant CO readout in the display, the individual has undoubtedly been exposed.

The main therapy for CO poisoning is the administering of supplemental oxygen and ventilatory support and the monitoring of heart rate.  The goal of oxygen therapy is to improve the O₂ content of the blood.  O₂ therapy and observations should continue long enough to prevent additional poisoning once carboxyhemoglobin unloads from the cell. 

No set guideline for length of therapy is given and health professionals readily admit that there is a tremendous amount of unknown health effects from CO exposure.

Currently Accepted Medical Symptoms of Carbon Monoxide Poisoning 

Keep in mind that this study was conducted in the early 1950’s on US Army ‘volunteers’.  As a result this study involved healthy young adult men. 

When we find carbon monoxide inside the buildings we are servicing and it exceeds the levels outside, our role becomes more vital. Who is in the building?  Are they all young, and health adults?  Casual inquiries about the general health of the inhabitants may reveal minor or compounded illness symptoms associated to the levels you measured. 

ALL EFFECTS CAN VARY SIGNIFICANTLY BASED UPON AGE, SEX, WEIGHT AND OVERALL STATE OF HEALTH.

It is vital that a cooperative relationship guide all activity associated with carbon monoxide incidences.  Just as consistent step-by-step procedures be used when in a home or building, a diagnostic checklist concerning poor health patterns or symptoms should also be used.  This checklist may be useful to everyone in the field as well as health care professionals or emergency responders.

Carbon monoxide is everybody’s business.

Signs and symptoms of carbon monoxide poisoning

If carbon monoxide is measured within the living or working space of a building, the following diagnostic approach may aid in the discovery of its source and perhaps its affect on the inhabitants. 

This discovery begins with questions.

If a caller reports a carbon monoxide alarm, the dispatcher/technician must find out if anyone at the location has any of the above symptoms and may choose to further explore the symptoms through the following questionnaire.  In some jurisdictions, a carbon monoxide alarm reported means immediate dispatching of a response team regardless of the symptoms.