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Review Article| Volume 26, ISSUE 1, P99-125, March 2006

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Toxicity Associated with Carbon Monoxide

  • Louise W. Kao
    Correspondence
    Corresponding author. Department of Emergency Medicine, Indiana State University School of Medicine, 1701 North Senate Boulevard, Indianapolis, IN 46206.
    Affiliations
    Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Medical Toxicology of Indiana, Indiana Poison Center, Indianapolis, IN, USA
    Search for articles by this author
  • Kristine A. Nañagas
    Affiliations
    Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Medical Toxicology of Indiana, Indiana Poison Center, Indianapolis, IN, USA
    Search for articles by this author
      Carbon monoxide (CO) has been called a “great mimicker.” The clinical presentations associated with CO toxicity may be diverse and nonspecific, including syncope, new-onset seizure, flu-like illness, headache, and chest pain. Unrecognized CO exposure may lead to significant morbidity and mortality. Even when the diagnosis is certain, appropriate therapy is widely debated.
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      References

        • Tomaszewski C.
        Carbon monoxide.
        in: Goldfrank L.R. Flomenbaum N.E. Lewin N.A. Goldfrank's toxicologic emergencies. 7th edition. McGraw-Hill, New York2002: 1478-1497
        • Cobb N.
        • Etzel R.A.
        Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988.
        JAMA. 1991; 266: 659-663
        • Raub J.A.
        • Mathieu-Nolf M.
        • Hampson N.B.
        • et al.
        Carbon monoxide poisoning—a public health perspective.
        Toxicology. 2000; 145: 1-14
        • Mott J.A.
        • Wolfe M.I.
        • Alverson C.J.
        • et al.
        National vehicle emissions policies and practices and declining US carbon monoxide–related mortality.
        JAMA. 2002; 288: 988-995
      1. Mah JC. Non-fire carbon monoxide deaths and injuries associated with the use of consumer products: annual estimates—1998. US Consumer Product Safety Commission (Bethesda, MD). Available at: http://www.cpsc.gov/library/data.html. Accessed February 4, 2005.

        • Ernst A.
        • Zibrak J.D.
        Carbon monoxide poisoning.
        N Engl J Med. 1998; 339: 1603-1608
        • Abelsohn A.
        • Sanborn M.D.
        • Jessiman B.J.
        • et al.
        Identifying and managing adverse environmental health effects. 6. Carbon monoxide poisoning.
        CMAJ. 2002; 166: 1685-1690
        • Ilano A.L.
        • Raffin T.A.
        Management of carbon monoxide poisoning.
        Chest. 1990; 97: 165-169
        • Olson K.R.
        Carbon monoxide poisoning: mechanisms, presentation, and controversies in management.
        J Emerg Med. 1984; 1: 233-243
        • Forbes W.H.
        • Sargent F.
        • Roughton F.J.W.
        The rate of carbon monoxide uptake by normal men.
        Am J Physiol. 1945; 143: 594-608
        • Roughton F.J.W.
        The kinetics of the reaction CO + O2Hb <−> O2 + COHb in human blood at body temperature.
        Am J Physiol. 1945; 143: 609-620
        • Widdop B.
        Analysis of carbon monoxide.
        Ann Clin Biochem. 2002; 39: 378-391
        • Raub J.A.
        • Benignus V.A.
        Carbon monoxide and the nervous system.
        Neurosci Biobehav Rev. 2002; 26: 925-940
      2. Administration OSHA. Occupational safety and health guidelines for carbon monoxide. Available at: http://www.osha.gov/SLTC/healthguidelines/carbonmonoxide/recognition.html. Accessed February 4, 2005.

        • Hampson N.B.
        • Norkool D.M.
        Carbon monoxide poisoning in children riding in the back of pickup trucks.
        JAMA. 1992; 267: 538-540
        • Anonymous
        Carbon-monoxide poisoning resulting from exposure to ski-boat exhaust—Georgia, June 2002.
        MMWR Morbid Mortal Wkly Rep. 2002; 51: 829-830
        • Silvers S.M.
        • Hampson N.B.
        Carbon monoxide poisoning among recreational boaters.
        JAMA. 1995; 274: 1614-1616
        • Anonymous
        From the Centers for Disease Control and Prevention. Carbon monoxide poisoning associated with use of LPG-powered (propane) forklifts in industrial settings—Iowa, 1998.
        JAMA. 2000; 283: 331-332
        • Ely E.W.
        • Moorehead B.
        • Haponik E.F.
        Warehouse workers' headache: emergency evaluation and management of 30 patients with carbon monoxide poisoning.
        Am J Med. 1995; 98: 145-155
        • Fawcett T.A.
        • Moon R.E.
        • Fracica P.J.
        • et al.
        Warehouse workers' headache. Carbon monoxide poisoning from propane-fueled forklifts.
        J Occup Med. 1992; 34: 12-15
        • Pelham T.W.
        • Holt L.E.
        • Moss M.A.
        Exposure to carbon monoxide and nitrogen dioxide in enclosed ice arenas.
        Occup Environ Med. 2002; 59: 224-233
        • Anonymous
        Carbon monoxide poisoning at an indoor ice arena and bingo hall—Seattle, 1996. From the Centers for Disease Control and Prevention.
        JAMA. 1996; 275: 1468-1469
        • Anonymous
        From the Centers for Disease Control and Prevention. Houseboat-associated carbon monoxide poisonings on Lake Powell—Arizona and Utah, 2000.
        JAMA. 2001; 285: 530-532
        • Anonymous
        From the Centers for Disease Control and Prevention. Carbon monoxide poisoning deaths associated with camping—Georgia, March 1999.
        JAMA. 1999; 282: 1326
        • Heckerling P.S.
        • Leikin J.B.
        • Maturen A.
        • et al.
        Predictors of occult carbon monoxide poisoning in patients with headache and dizziness.
        Ann Intern Med. 1987; 107: 174-176
        • Hampson N.B.
        • Kramer C.C.
        • Dunford R.G.
        • et al.
        Carbon monoxide poisoning from indoor burning of charcoal briquets.
        JAMA. 1994; 271: 52-53
        • Wrenn K.
        • Connors G.P.
        Carbon monoxide poisoning during ice storms: a tale of two cities.
        J Emerg Med. 1997; 15: 465-467
        • Rioux J.P.
        • Myers R.A.
        Hyperbaric oxygen for methylene chloride poisoning: report on two cases.
        Ann Emerg Med. 1989; 18: 691-695
        • Nager E.C.
        • O'Connor R.E.
        Carbon monoxide poisoning from spray paint inhalation.
        Acad Emerg Med. 1998; 5: 84-86
        • Langehennig P.L.
        • Seeler R.A.
        • Berman E.
        Paint removers and carboxyhemoglobin.
        N Engl J Med. 1976; 295: 1137
        • Piantadosi C.A.
        Diagnosis and treatment of carbon monoxide poisoning.
        Respir Care Clin N Am. 1999; 5: 183-202
        • Naik J.S.
        • O'Donaughy T.L.
        • Walker B.R.
        Endogenous carbon monoxide is an endothelial-derived vasodilator factor in the mesenteric circulation.
        Am J Physiol Heart Circ Physiol. 2003; 284: H838-H845
        • Zegdi R.
        • Perrin D.
        • Burdin M.
        • et al.
        Increased endogenous carbon monoxide production in severe sepsis.
        Intensive Care Med. 2002; 28: 793-796
        • Haldane J.
        Medicolegal contributions of historical interest. The action of carbonic oxide on man.
        Forensic Sci. 1972; 1: 451-483
        • Sendroy J.
        • Liu S.H.
        • Van Slyke D.O.
        The gasometric estimation of the relative affinity constant for carbon monoxide and oxygen in whole blood at 38C.
        Am J Physiol. 1929; 90: 511-512
        • Roughton F.J.W.
        • Darling R.C.
        The effect of carbon monoxide on the oxyhemoglobin dissociation curve.
        Am J Physiol. 1944; 141: 17-31
        • Goldbaum L.R.
        • Ramirez R.G.
        • Absalon K.B.
        What is the mechanism of carbon monoxide toxicity?.
        Aviat Space Environ Med. 1975; 46: 1289-1291
        • Goldbaum L.R.
        • Orellano T.
        • Dergal E.
        Mechanism of the toxic action of carbon monoxide.
        Ann Clin Lab Sci. 1976; 6: 372-376
        • Orellano T.
        • Dergal E.
        • Alijani M.
        • et al.
        Studies on the mechanism of carbon monoxide toxicity.
        J Surg Res. 1976; 20: 485-487
        • Ramirez R.G.
        • Albert S.N.
        • Agostin J.C.
        • et al.
        Lack of toxicity of transfused carboxyhemoglobin.
        Surg Forum. 1974; 25: 165-168
        • Meilin S.
        • Rogatsky G.G.
        • Thom S.R.
        • et al.
        Effects of carbon monoxide on the brain may be mediated by nitric oxide.
        J Appl Physiol. 1996; 81: 1078-1083
        • Mendelman A.
        • Zarchin N.
        • Meilin S.
        • et al.
        Blood flow and ionic responses in the awake brain due to carbon monoxide.
        Neurol Res. 2002; 24: 765-772
        • Rottman S.J.
        Carbon monoxide screening in the ED.
        Am J Emerg Med. 1991; 9: 204-205
        • Norkool D.M.
        • Kirkpatrick J.N.
        Treatment of acute carbon monoxide poisoning with hyperbaric oxygen: a review of 115 cases.
        Ann Emerg Med. 1985; 14: 1168-1171
        • Myers R.A.
        Carbon monoxide poisoning.
        J Emerg Med. 1984; 1: 245-248
        • Okeda R.
        • Funata N.
        • Takano T.
        • et al.
        The pathogenesis of carbon monoxide encephalopathy in the acute phase—physiological and morphological correlation.
        Acta Neuropathol (Berl). 1981; 54: 1-10
        • Brown S.D.
        • Piantadosi C.A.
        Recovery of energy metabolism in rat brain after carbon monoxide hypoxia.
        J Clin Invest. 1992; 89: 666-672
        • Hill B.C.
        The pathway of CO binding to cytochrome c oxidase. Can the gateway be closed?.
        FEBS Lett. 1994; 354: 284-288
        • Chance B.
        • Erecinska M.
        • Wagner M.
        Mitochondrial responses to carbon monoxide toxicity.
        Ann N Y Acad Sci. 1970; 174: 193-204
        • Hardy K.R.
        • Thom S.R.
        Pathophysiology and treatment of carbon monoxide poisoning.
        J Toxicol Clin Toxicol. 1994; 32: 613-629
        • Zhang J.
        • Piantadosi C.A.
        Mitochondrial oxidative stress after carbon monoxide hypoxia in the rat brain.
        J Clin Invest. 1992; 90: 1193-1199
        • Thom S.R.
        • Ohnishi S.T.
        • Ischiropoulos H.
        Nitric oxide released by platelets inhibits neutrophil B2 integrin function following acute carbon monoxide poisoning.
        Toxicol Appl Pharmacol. 1994; 128: 105-110
        • Radi R.
        • Rodriguez M.
        • Castro L.
        • et al.
        Inhibition of mitochondrial electron transport by peroxynitrite.
        Arch Biochem Biophys. 1994; 308: 89-95
        • Piantadosi C.A.
        • Tatro L.
        • Zhang J.
        Hydroxyl radical production in the brain after CO hypoxia in rats.
        Free Rad Biol Med. 1995; 18: 603-609
        • DeBias D.A.
        • Banerjee C.M.
        • Birkhead N.C.
        • et al.
        Effects of carbon monoxide inhalation on ventricular fibrillation.
        Arch Environ Health. 1976; 31: 42-46
        • Sangalli B.C.
        • Bidanset J.H.
        A review of carboxymyoglobin formation: a major mechanism of carbon monoxide toxicity.
        Vet Hum Toxicol. 1990; 32: 449-453
        • Florkowski C.M.
        • Rossi M.L.
        • Carey M.P.
        • et al.
        Rhabdomyolysis and acute renal failure following carbon monoxide poisoning: two case reports with muscle histopathology and enzyme activities.
        J Toxicol Clin Toxicol. 1992; 30: 443-454
        • Wolff E.
        Carbon monoxide poisoning with severe myonecrosis and acute renal failure.
        Am J Emerg Med. 1994; 12: 347-349
        • Herman G.D.
        • Shapiro A.B.
        • Leikin J.
        Myonecrosis in carbon monoxide poisoning.
        Vet Hum Toxicol. 1988; 30: 28-30
        • Richardson R.S.
        • Noyszewski E.A.
        • Saltin B.
        • et al.
        Effect of mild carboxy-hemoglobin on exercising skeletal muscle: intravascular and intracellular evidence.
        Am J Physiol. 2002; 283: R1131-R1139
        • Barinaga M.
        Carbon monoxide: killer to brain messenger in one step.
        Science. 1993; 259: 309
        • Verma A.
        • Hirsch D.J.
        • Glatt C.E.
        • et al.
        Carbon monoxide: a putative neural messenger.
        Science. 1993; 259: 381-384
        • Meyer-Witting M.
        • Helps S.
        • Gorman D.F.
        Acute carbon monoxide exposure and cerebral blood flow in rabbits.
        Anaesth Intensive Care. 1991; 19: 373-377
        • Sinha A.K.
        • Klein J.
        • Schultze P.
        • et al.
        Cerebral regional capillary perfusion and blood flow after carbon monoxide exposure.
        J Appl Physiol. 1991; 71: 1196-1200
        • Jiang J.
        • Tyssebotn I.
        Cerebrospinal fluid pressure changes after acute carbon monoxide poisoning and therapeutic effects of normobaric and hyperbaric oxygen in conscious rats.
        Undersea Hyperb Med. 1997; 24: 245-254
        • Ischiropoulos H.
        • Beers M.F.
        • Ohnishi S.T.
        • et al.
        Nitric oxide production and perivascular tyrosine nitration in brain after carbon monoxide poisoning in the rat.
        J Clin Invest. 1996; 97: 2260-2267
        • Landry D.W.
        • Oliver J.A.
        The pathogenesis of vasodilatory shock.
        N Engl J Med. 2001; 345: 588-595
        • Ginsberg M.D.
        • Myers R.E.
        • McDonagh B.F.
        Experimental carbon monoxide encephalopathy in the primate. II. Clinical aspects, neuropathology, and physiologic correlation.
        Arch Neurol. 1974; 30: 209-216
        • Koehler R.C.
        • Jones Jr., M.D.
        • Traystman R.J.
        Cerebral circulatory response to carbon monoxide and hypoxic hypoxia in the lamb.
        Am J Physiol. 1982; 243: H27-H32
        • Okeda R.
        • Funata N.
        • Song S.J.
        • et al.
        Comparative study on pathogenesis of selective cerebral lesions in carbon monoxide poisoning and nitrogen hypoxia in cats.
        Acta Neuropathol (Berl). 1982; 56: 265-272
        • Song S.Y.
        • Okeda R.
        • Funata N.
        • et al.
        An experimental study of the pathogenesis of the selective lesion of the globus pallidus in acute carbon monoxide poisoning in cats.
        Acta Neuropathol (Berl). 1983; 61: 232-238
        • Thom S.R.
        • Kang M.
        • Fisher D.
        • et al.
        Release of glutathione from erythrocytes and other markers of oxidative stress in carbon monoxide poisoning.
        J Appl Physiol. 1997; 82: 1424-1432
        • Thom S.R.
        Leukocytes in carbon monoxide–mediated brain oxidative injury.
        Toxicol Appl Pharmacol. 1993; 123: 234-247
        • Thom S.R.
        • Fisher D.
        • Manevich Y.
        Roles for platelet-activating factor and NO-derived oxidants causing neutrophil adherence after CO poisoning.
        Am J Physiol Heart Circ Physiol. 2001; 281: H923-H930
        • Tomaszewski C.
        • Rosenberg N.
        • Wanthen J.
        • et al.
        Prevention of neurological sequelae from carbon monoxide by hyperbaric oxygen in rats.
        Neurology. 1992; 42: 196
        • Thom S.R.
        Carbon monoxide–mediated brain lipid peroxidation in the rat.
        J Appl Physiol. 1990; 68: 997-1003
        • Thom S.R.
        Dehydrogenase conversion to oxidase and lipid peroxidation in brain after carbon monoxide poisoning.
        J Appl Physiol. 1992; 73: 1584-1589
        • Penney D.G.
        Acute carbon monoxide poisoning: animal models: a review.
        Toxicology. 1990; 62: 123-160
        • Thom S.R.
        • Bhopale V.M.
        • Fisher D.
        • et al.
        Delayed neuropathology after carbon monoxide poisoning is immune-mediated.
        Proc Natl Acad Sci U S A. 2004; 101: 13660-13665
        • Piantadosi C.A.
        • Zhang J.
        • Levin E.D.
        • et al.
        Apoptosis and delayed neuronal damage after carbon monoxide poisoning in the rat.
        Exp Neurol. 1997; 147: 103-114
        • Penney D.G.
        • Chen K.
        NMDA receptor–blocker ketamine protects during acute carbon monoxide poisoning, while calcium channel–blocker verapamil does not.
        J Appl Toxicol. 1996; 16: 297-304
        • Ishimaru H.
        • Katoh A.
        • Suzuki H.
        • et al.
        Effects of N-methyl-D-aspartate receptor antagonists on carbon monoxide–induced brain damage in mice.
        J Pharmacol Exp Ther. 1992; 261: 349-352
        • Lightfoot N.F.
        Chronic carbon monoxide exposure.
        Proc R Soc Med. 1972; 65: 798-799
        • Thom S.R.
        • Fisher D.
        • Xu Y.A.
        • et al.
        Role of nitric oxide–derived oxidants in vascular injury from carbon monoxide in the rat.
        Am J Physiol. 1999; 276: H984-H992
        • Estabrook R.W.
        • Franklin M.R.
        • Hildebrandt A.G.
        Factors influencing the inhibitory effect of carbon monoxide on cytochrome P-450–catalyzed mixed function oxidation reactions.
        Ann N Y Acad Sci. 1970; 174: 218-232
        • Dolan M.C.
        • Haltom T.L.
        • Barrows G.H.
        • et al.
        Carboxyhemoglobin levels in patients with flu-like symptoms.
        Ann Emerg Med. 1987; 16: 782-786
        • Heckerling P.S.
        Occult carbon monoxide poisoning: a cause of winter headache.
        Am J Emerg Med. 1987; 5: 201-204
        • Baker M.D.
        • Henretig F.M.
        • Ludwig S.
        Carboxyhemoglobin levels in children with nonspecific flu-like symptoms.
        J Pediatr. 1988; 113: 501-504
        • Burney R.E.
        • Wu S.C.
        • Nemiroff M.J.
        Mass carbon monoxide poisonings: clinical effects and results of treatment in 184 victims.
        Ann Emerg Med. 1982; 11: 394-399
        • Stewart R.D.
        • Peterson J.E.
        • Baretta E.D.
        • et al.
        Experimental human exposure to carbon monoxide.
        Arch Environ Health. 1970; 21: 154-164
        • Stewart R.D.
        • Peterson J.E.
        • Fisher T.N.
        • et al.
        Experimental human exposure to high concentrations of carbon monoxide.
        Arch Environ Health. 1973; 26: 1-7
        • Herman L.Y.
        Carbon monoxide poisoning presenting as an isolated seizure.
        J Emerg Med. 1998; 16: 429-432
        • Mori T.
        • Nagai K.
        Carbon-monoxide poisoning presenting as an afebrile seizure.
        Pediatr Neurol. 2000; 22: 330-331
        • Silver D.A.
        • Cross M.
        • Fox B.
        • et al.
        Computed tomography of the brain in acute carbon monoxide poisoning.
        Clin Radiol. 1996; 51: 480-483
        • Jones J.S.
        • Lagasse J.
        • Zimmerman G.
        Computed tomographic findings after acute carbon monoxide poisoning.
        Am J Emerg Med. 1994; 12: 448-451
        • Miura T.
        • Mitomo M.
        • Kawai R.
        • et al.
        CT of the brain in acute carbon monoxide intoxication: characteristic features and prognosis.
        AJNR Am J Neuroradiol. 1985; 6: 739-742
        • Sawada Y.
        • Takahashi M.
        • Ohashi N.
        • et al.
        Computerised tomography as an indication of long-term outcome after acute carbon monoxide poisoning.
        Lancet. 1980; 1: 783-784
        • Penney D.G.
        Hemodynamic response to carbon monoxide.
        Environ Health Perspect. 1988; 77: 121-130
        • Yanir Y.
        • Shupak A.
        • Abramovich A.
        • et al.
        Cardiogenic shock complicating acute carbon monoxide poisoning despite neurologic and metabolic recovery.
        Ann Emerg Med. 2002; 40: 420-424
        • Thom S.R.
        • Keim L.W.
        Carbon monoxide poisoning: a review. Epidemiology, pathophysiology, clinical findings, and treatment options including hyperbaric oxygen therapy.
        J Toxicol Clin Toxicol. 1989; 27: 141-156
        • Atkins E.H.
        • Baker E.L.
        Exacerbation of coronary artery disease by occupational carbon monoxide exposure: a report to two fatalities and a review of the literature.
        Am J Ind Med. 1985; 7: 73-79
        • Aronow W.S.
        • Isbell M.W.
        Carbon monoxide effect on exercise-induced angina pectoris.
        Ann Intern Med. 1973; 79: 392-395
        • Sheps D.S.
        • Herbst M.C.
        • Hinderliter A.L.
        • et al.
        Production of arrhythmias by elevated carboxyhemoglobin in patients with coronary artery disease.
        Ann Intern Med. 1990; 113: 343-351
        • Allred E.N.
        • Bleecker E.R.
        • Chaitman B.R.
        • et al.
        Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease.
        N Engl J Med. 1989; 321: 1426-1432
        • Marius-Nunez A.L.
        Myocardial infarction with normal coronary arteries after acute exposure to carbon monoxide.
        Chest. 1990; 97: 491-494
        • Myers R.A.
        • Snyder S.K.
        • Majerus T.C.
        Cutaneous blisters and carbon monoxide poisoning.
        Ann Emerg Med. 1985; 14: 603-606
        • Thom S.R.
        Smoke inhalation.
        Emerg Med Clin North Am. 1989; 7: 371-387
        • Goulon M.
        • Barois A.
        • Rapin M.
        • et al.
        Carbon monoxide poisoning and acute anoxia due to breathing coal tar gas and hydrocarbons.
        Journal of Hyperbaric Medicine. 1986; 1: 23-41
        • Krantz T.
        • Thisted B.
        • Strom J.
        • et al.
        Acute carbon monoxide poisoning.
        Acta Anaesthesiol Scand. 1988; 32: 278-282
        • Vreman H.J.
        • Mahoney J.J.
        • Stevenson D.K.
        Carbon monoxide and carboxyhemoglobin.
        Adv Pediatr. 1995; 42: 303-334
        • Foster M.
        • Goodwin S.R.
        • Williams C.
        • et al.
        Recurrent acute life-threatening events and lactic acidosis caused by chronic carbon monoxide poisoning in an infant.
        Pediatrics. 1999; 104: e34
        • Crocker P.J.
        • Walker J.S.
        Pediatric carbon monoxide toxicity.
        J Emerg Med. 1985; 3: 443-448
        • Liebelt E.L.
        Hyperbaric oxygen therapy in childhood carbon monoxide poisoning.
        Curr Opin Pediatr. 1999; 11: 259-264
        • Longo L.D.
        • Hill E.P.
        Carbon monoxide uptake and elimination in fetal and maternal sheep.
        Am J Physiol. 1977; 232: H324-H330
        • Longo L.D.
        Carbon monoxide in the pregnant mother and fetus and its exchange across the placenta.
        Ann N Y Acad Sci. 1970; 174: 312-341
        • Norman C.A.
        • Halton D.M.
        Is carbon monoxide a workplace teratogen?.
        Ann Occup Hyg. 1990; 34: 335-347
        • Caravati E.M.
        • Adams C.J.
        • Joyce S.M.
        • et al.
        Fetal toxicity associated with maternal carbon monoxide poisoning.
        Ann Emerg Med. 1988; 17: 714-717
        • Koren G.
        • Sharav T.
        • Pastuszak A.
        • et al.
        A multicenter, prospective study of fetal outcome following accidental carbon monoxide poisoning in pregnancy.
        Reprod Toxicol. 1991; 5: 397-403
        • Farrow J.R.
        • Davis G.J.
        • Roy T.M.
        • et al.
        Fetal death due to nonlethal maternal carbon monoxide poisoning.
        J Forensic Sci. 1990; 35: 1448-1452
        • Cramer C.R.
        Fetal death due to accidental maternal carbon monoxide poisoning.
        J Toxicol Clin Toxicol. 1982; 19: 297-301
        • Ginsberg M.D.
        • Myers R.E.
        Fetal brain injury after maternal carbon monoxide intoxication. Clinical and neuropathologic aspects.
        Neurology. 1976; 26: 15-23
        • Woody R.C.
        • Brewster M.A.
        Telencephalic dysgenesis associated with presumptive maternal carbon monoxide intoxication in the first trimester of pregnancy.
        J Toxicol Clin Toxicol. 1990; 28: 467-475
        • Elkharrat D.
        • Raphael J.C.
        • Korach J.M.
        • et al.
        Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy.
        Intensive Care Med. 1991; 17: 289-292
        • Garland H.
        • Pearce J.
        Neurological complications of carbon monoxide poisoning.
        Q J Med. 1967; 36: 445-455
        • Min S.K.
        A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication.
        Acta Psychiatr Scand. 1986; 73: 80-86
        • Choi I.S.
        Delayed neurologic sequelae in carbon monoxide intoxication.
        Arch Neurol. 1983; 40: 433-435
        • Myers R.A.
        • Snyder S.K.
        • Emhoff T.A.
        Subacute sequelae of carbon monoxide poisoning.
        Ann Emerg Med. 1985; 14: 1163-1167
        • Lee M.S.
        • Marsden C.D.
        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: 550-558
        • Smith J.S.
        • Brandon S.
        Morbidity from acute carbon monoxide poisoning at three-year follow-up.
        BMJ. 1973; 1: 318-321
        • Raphael J.C.
        • Elkharrat D.
        • Jars-Guincestre M.C.
        • et al.
        Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication.
        Lancet. 1989; 2: 414-419
        • Shillito F.H.
        • Drinker C.K.
        • Shaughnessy T.J.
        The problem of nervous and mental sequelae in carbon monoxide poisoning.
        JAMA. 1936; 106: 669-674
        • Kim J.K.
        • Coe C.J.
        Clinical study on carbon monoxide intoxication in children.
        Yonsei Med J. 1987; 28: 266-273
        • Parkinson R.B.
        • Hopkins R.O.
        • Cleavinger H.B.
        • et al.
        White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning.
        Neurology. 2002; 58: 1525-1532
        • Mathieu D.
        • Nolf M.
        • Durocher A.
        • et al.
        Acute carbon monoxide poisoning. Risk of late sequelae and treatment by hyperbaric oxygen.
        J Toxicol Clin Toxicol. 1985; 23: 315-324
        • Schiltz K.L.
        Failure to assess motivation, need to consider psychiatric variables, and absence of comprehensive examination: a skeptical review of neuropsychologic assessment in carbon monoxide research.
        Undersea Hyperb Med. 2000; 27: 48-50
        • Seger D.
        • Welch L.
        Carbon monoxide controversies: neuropsychologic testing, mechanism of toxicity, and hyperbaric oxygen.
        Ann Emerg Med. 1994; 24: 242-248
        • Hampson N.B.
        • Mathieu D.
        • Piantadosi C.A.
        • et al.
        Carbon monoxide poisoning: interpretation of randomized clinical trials and unresolved treatment issues.
        Undersea Hyperb Med. 2001; 28: 157-164
        • Deschamps D.
        • Geraud C.
        • Julien H.
        • et al.
        Memory one month after acute carbon monoxide intoxication: a prospective study.
        Occup Environ Med. 2003; 60: 212-216
        • Gorman D.
        • Drewry A.
        • Huang Y.L.
        • et al.
        The clinical toxicology of carbon monoxide.
        Toxicology. 2003; 187: 25-38
        • Watkins C.G.
        • Strope G.L.
        Chronic carbon monoxide poisoning as a major contributing factor in the sudden infant death syndrome.
        Am J Dis Child. 1986; 140: 619
        • Halpern J.S.
        Chronic occult carbon monoxide poisoning.
        J Emerg Nurs. 1989; 15: 107-111
        • Manuel J.
        A healthy home environment?.
        Environ Health Perspect. 1999; 107: A352-A357
        • Wright J.
        Chronic and occult carbon monoxide poisoning: we don't know what we're missing.
        Emerg Med J. 2002; 19: 386-390
        • Devine S.A.
        • Kirkley S.M.
        • Palumbo C.L.
        • et al.
        MRI and neuropsychological correlates of carbon monoxide exposure: a case report.
        Environ Health Perspect. 2002; 110: 1051-1055
        • Gilbert G.J.
        • Glaser G.H.
        Neurologic manifestations of chronic carbon monoxide poisoning.
        N Engl J Med. 1959; 261: 1217-1220
        • Thorpe M.
        Chronic carbon monoxide poisoning.
        Can J Psychiatry. 1994; 39: 59-61
        • Khan K.
        • Sharief N.
        Chronic carbon monoxide poisoning in children.
        Acta Paediatr. 1995; 84: 742
        • Myers R.A.
        • DeFazio A.
        • Kelly M.P.
        Chronic carbon monoxide exposure: a clinical syndrome detected by neuropsychological tests.
        J Clin Psychol. 1998; 54: 555-567
        • Knobeloch L.
        • Jackson R.
        Recognition of chronic carbon monoxide poisoning.
        Wis Med J. 1999; 98: 26-29
        • Pavese N.
        • Napolitano A.
        • De Iaco G.
        • et al.
        Clinical outcome and magnetic resonance imaging of carbon monoxide intoxication. A long-term follow-up study.
        Ital J Neurol Sci. 1999; 20: 171-178
        • Townsend C.L.
        • Maynard R.L.
        Effects on health of prolonged exposure to low concentrations of carbon monoxide.
        Occup Environ Med. 2002; 59: 708-711
      3. Ritz B, Yu F, Chapa G, et al. Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993 2000;11(5):502–11.

        • Ritz B.
        • Yu F.
        • Fruin S.
        • et al.
        Ambient air pollution and risk of birth defects in Southern California.
        Am J Epidemiol. 2002; 155: 17-25
        • Fechter L.D.
        • Karpa M.D.
        • Proctor B.
        • et al.
        Disruption of neostriatal development in rats following perinatal exposure to mild, but chronic carbon monoxide.
        Neurotoxicol Teratol. 1987; 9: 277-281
        • Weir F.W.
        • Fabiano V.L.
        Re-evaluation of the role of carbon monoxide in production or aggravation of cardiovascular disease processes.
        J Occup Med. 1982; 24: 519-525
        • Morris R.D.
        • Naumova E.N.
        • Munasinghe R.L.
        Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities.
        Am J Public Health. 1995; 85: 1361-1365
        • Heckerling P.S.
        • Leikin J.B.
        • Terzian C.G.
        • et al.
        Occult carbon monoxide poisoning in patients with neurologic illness.
        J Toxicol Clin Toxicol. 1990; 28: 29-44
        • Stewart R.D.
        • Baretta E.D.
        • Platte L.R.
        • et al.
        Carboxyhemoglobin levels in American blood donors.
        JAMA. 1974; 229: 1187-1195
        • Benignus V.A.
        • Kafer E.R.
        • Muller K.E.
        • et al.
        Absence of symptoms with carboxyhemoglobin levels of 16–23%.
        Neurotoxicol Teratol. 1987; 9: 345-348
        • Sokal J.A.
        • Kralkowska E.
        The relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man.
        Arch Toxicol. 1985; 57: 196-199
        • Davis S.M.
        • Levy R.C.
        High carboxyhemoglobin level without acute or chronic findings.
        J Emerg Med. 1984; 1: 539-542
        • Kurt T.L.
        • Anderson R.J.
        • Reed W.G.
        Rapid estimation of carboxyhemoglobin by breath sampling in an emergency setting.
        Vet Hum Toxicol. 1990; 32: 227-229
        • Touger M.
        • Gallagher E.J.
        • Tyrell J.
        Relationship between venous and arterial carboxyhemoglobin levels in patients with suspected carbon monoxide poisoning.
        Ann Emerg Med. 1995; 25: 481-483
        • Lopez D.M.
        • Weingarten-Arams J.S.
        • Singer L.P.
        • et al.
        Relationship between arterial, mixed venous, and internal jugular carboxyhemoglobin concentrations at low, medium, and high concentrations in a piglet model of carbon monoxide toxicity.
        Crit Care Med. 2000; 28: 1998-2001
        • Bozeman W.P.
        • Myers R.A.
        • Barish R.A.
        Confirmation of the pulse oximetry gap in carbon monoxide poisoning.
        Ann Emerg Med. 1997; 30: 608-611
        • Buckley R.G.
        • Aks S.E.
        • Eshom J.L.
        • et al.
        The pulse oximetry gap in carbon monoxide intoxication.
        Ann Emerg Med. 1994; 24: 252-255
        • Hampson N.B.
        Pulse oximetry in severe carbon monoxide poisoning.
        Chest. 1998; 114: 1036-1041
        • Larkin J.M.
        • Brahos G.J.
        • Moylan J.A.
        Treatment of carbon monoxide poisoning: prognostic factors.
        J Trauma. 1976; 16: 111-114
        • Holstege C.P.
        • Baer A.B.
        • Eldridge D.L.
        • et al.
        Case series of elevated troponin I following carbon monoxide poisoning.
        J Toxicol Clin Toxicol. 2004; 42: 742-743
        • Shusterman D.
        • Alexeeff G.
        • Hargis C.
        • et al.
        Predictors of carbon monoxide and hydrogen cyanide exposure in smoke inhalation patients.
        J Toxicol Clin Toxicol. 1996; 34: 61-71
        • Van Hoesen K.B.
        • Camporesi E.M.
        • Moon R.E.
        • et al.
        Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review.
        JAMA. 1989; 261: 1039-1043
        • Rasmussen L.S.
        • Poulsen M.G.
        • Christiansen M.
        • et al.
        Biochemical markers for brain damage after carbon monoxide poisoning.
        Acta Anaesthesiol Scand. 2004; 48: 469-473
        • Brvar M.
        • Mozina H.
        • Osredkar J.
        • et al.
        S100B protein in carbon monoxide poisoning: a pilot study.
        Resuscitation. 2004; 61: 357-360
        • Brvar M.
        • Mozina H.
        • Osredkar J.
        • et al.
        The potential value of the protein S-100B level as a criterion for hyperbaric oxygen treatment and prognostic marker in carbon monoxide poisoned patients.
        Resuscitation. 2003; 56: 105-109
        • Messier L.D.
        • Myers R.A.
        A neuropsychological screening battery for emergency assessment of carbon-monoxide-poisoned patients.
        J Clin Psychol. 1991; 47: 675-684
        • Amitai Y.
        • Zlotogorski Z.
        • Golan-Katzav V.
        • et al.
        Neuropsychological impairment from acute low-level exposure to carbon monoxide.
        Arch Neurol. 1998; 55: 845-848
        • Hay P.J.
        • Denson L.A.
        • van Hoof M.
        • et al.
        The neuropsychiatry of carbon monoxide poisoning in attempted suicide: a prospective controlled study.
        J Psychosom Res. 2002; 53: 699-708
        • Myers R.A.
        • Britten J.S.
        Are arterial blood gases of value in treatment decisions for carbon monoxide poisoning?.
        Crit Care Med. 1989; 17: 139-142
        • Hampson N.B.
        • Dunford R.G.
        • Kramer C.C.
        • et al.
        Selection criteria utilized for hyperbaric oxygen treatment of carbon monoxide poisoning.
        J Emerg Med. 1995; 13: 227-231
        • Hart I.K.
        • Kennedy P.G.
        • Adams J.H.
        • et al.
        Neurological manifestation of carbon monoxide poisoning.
        Postgrad Med J. 1988; 64: 213-216
        • Vieregge P.
        • Klostermann W.
        • Blumm R.G.
        • et al.
        Carbon monoxide poisoning: clinical, neurophysiological, and brain imaging observations in acute disease and follow-up.
        J Neurol. 1989; 236: 478-481
        • Zagami A.S.
        • Lethlean A.K.
        • Mellick R.
        Delayed neurological deterioration following carbon monoxide poisoning: MRI findings.
        J Neurol. 1993; 240: 113-116
        • Gale S.D.
        • Hopkins R.O.
        • Weaver L.K.
        • et al.
        MRI, quantitative MRI, SPECT, and neuropsychological findings following carbon monoxide poisoning.
        Brain Inj. 1999; 13: 229-243
        • Denays R.
        • Makhoul E.
        • Dachy B.
        • et al.
        Electroencephalographic mapping and 99mTc HMPAO single-photon emission computed tomography in carbon monoxide poisoning.
        Ann Emerg Med. 1994; 24: 947-952
        • Ducasse J.L.
        • Celsis P.
        • Marc-Vergnes J.P.
        Non-comatose patients with acute carbon monoxide poisoning: hyperbaric or normobaric oxygenation?.
        Undersea Hyperb Med. 1995; 22: 9-15
        • Choi I.S.
        • Kim S.K.
        • Lee S.S.
        • et al.
        Evaluation of outcome of delayed neurologic sequelae after carbon monoxide poisoning by technetium-99m hexamethylpropylene amine oxime brain single photon emission computed tomography.
        Eur Neurol. 1995; 35: 137-142
        • Winter P.M.
        • Miller J.N.
        Carbon monoxide poisoning.
        JAMA. 1976; 236: 1502
        • Thom S.R.
        Antidotes in depth: hyperbaric oxygen.
        in: Goldfrank L.R. Flomenbaum N.E. Lewin N.A. Goldfrank's toxicologic emergencies. 7th edition. McGraw-Hill, New York2002: 1492-1497
        • Boerema I.
        • Meyne N.G.
        • Brummelkamp W.H.
        • et al.
        Life without blood.
        Arch Chir Neerl. 1959; 11: 70
        • Pace N.
        • Stajman E.
        • Walker E.L.
        Acceleration of carbon monoxide elimination in man by high pressure oxygen.
        Science. 1950; 111: 652-654
        • Jay G.D.
        • McKindley D.S.
        Alterations in pharmacokinetics of carboxyhemoglobin produced by oxygen under pressure.
        Undersea Hyperb Med. 1997; 24: 165-173
        • Araki R.
        • Nashimoto I.
        • Takano T.
        The effect of hyperbaric oxygen on cerebral hemoglobin oxygenation and dissociation rate of carboxyhemoglobin in anesthetized rats: spectroscopic approach.
        Adv Exp Med Biol. 1988; 222: 375-381
        • Peterson J.E.
        • Stewart R.D.
        Absorption and elimination of carbon monoxide by inactive young men.
        Arch Environ Health. 1970; 21: 165-171
        • Smith G.
        The treatment of carbon monoxide poisoning with oxygen at two atmospheres absolute.
        Ann Occup Hyg. 1962; 5: 259-263
        • End E.
        • Long C.W.
        Oxygen under pressure in carbon monoxide poisoning.
        J Ind Hyg Toxicol. 1942; 24: 302-306
        • Thom S.R.
        Antagonism of carbon monoxide–mediated brain lipid peroxidation by hyperbaric oxygen.
        Toxicol Appl Pharmacol. 1990; 105: 340-344
        • Brown S.D.
        • Piantadosi C.A.
        Reversal of carbon monoxide–cytochrome c oxidase binding by hyperbaric oxygen in vivo.
        Adv Exp Med Biol. 1989; 248: 747-754
        • Thom S.R.
        Functional inhibition of leukocyte B2 integrins by hyperbaric oxygen in carbon monoxide–mediated brain injury in rats.
        Toxicol Appl Pharmacol. 1993; 123: 248-256
        • Thom S.R.
        • Mendiguren I.
        • Nebolon M.
        Temporary inhibition of human neutrophil B2 integrin function by hyperbaric oxygen (HBO).
        Clin Res. 1994; 42: 130A
        • Jiang J.
        • Tyssebotn I.
        Normobaric and hyperbaric oxygen treatment of acute carbon monoxide poisoning in rats.
        Undersea Hyperb Med. 1997; 24: 107-116
        • Gilmer B.
        • Kilkenny J.
        • Tomaszewski C.
        • et al.
        Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning.
        Acad Emerg Med. 2002; 9: 1-8
        • Piantadosi C.A.
        Carbon monoxide poisoning.
        N Engl J Med. 2002; 347: 1054-1055
        • Thom S.R.
        • Taber R.L.
        • Mendiguren II,
        • et al.
        Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen.
        Ann Emerg Med. 1995; 25: 474-480
        • Mathieu D.
        • Wattel F.
        • Mathieu-Nolf M.
        • et al.
        Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non comatose CO poisoned patients: results of the interim analysis.
        Undersea Hyperb Med. 1996; 23: 7-8
        • Scheinkestel C.D.
        • Bailey M.
        • Myles P.S.
        • et al.
        Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial.
        Med J Aust. 1999; 170: 203-210
        • Weaver L.K.
        • Hopkins R.O.
        • Chan K.J.
        • et al.
        Hyperbaric oxygen for acute carbon monoxide poisoning.
        N Engl J Med. 2002; 347: 1057-1067
        • Weaver L.K.
        • Hopkins R.O.
        • Larson-Lohr V.
        Carbon monoxide poisoning: a review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen.
        Ann Emerg Med. 1995; 25: 271-272
        • Tibbles P.M.
        • Perrotta P.L.
        Treatment of carbon monoxide poisoning: a critical review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen.
        Ann Emerg Med. 1994; 24: 269-276
        • Juurlink D.N.
        • Stanbrook M.B.
        • McGuigan M.A.
        Hyperbaric oxygen for carbon monoxide poisoning.
        Cochrane Database Syst Rev. 2000; 2 (CD002041)
        • Thom S.R.
        Hyperbaric-oxygen therapy for acute carbon monoxide poisoning.
        N Engl J Med. 2002; 347: 1105-1106
        • Olson K.R.
        • Seger D.
        Hyperbaric oxygen for carbon monoxide poisoning: does it really work?.
        Ann Emerg Med. 1995; 25: 535-537
        • Scheinkestel C.D.
        • Tuxen D.V.
        • Bailey M.
        • et al.
        Hyperbaric oxygen in carbon monoxide poisoning. Authors of study clarify points that they made.
        BMJ. 2000; 321 ([author reply: 110–1]): 109-110
        • Unsworth I.P.
        Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial. Was the best treatment protocol used?.
        Med J Aust. 1999; 170: 564-565
        • Kindwall E.P.
        Hyperbaric treatment of carbon monoxide poisoning.
        Ann Emerg Med. 1985; 14: 1233-1234
        • Tomaszewski C.A.
        • Thom S.R.
        Use of hyperbaric oxygen in toxicology.
        Emerg Med Clin North Am. 1994; 12: 437-459
        • Myers R.A.
        • Snyder S.K.
        • Linberg S.
        • et al.
        Value of hyperbaric oxygen in suspected carbon monoxide poisoning.
        JAMA. 1981; 246: 2478-2480
        • Myers R.A.M.
        • Thom S.R.
        Carbon monoxide and cyanide poisoning.
        in: Kindwall E.P. Hyperbaric medicine practice. Best Publishing, Flagstaff (AZ)1994: 357
        • Van Meter K.W.
        • Weiss L.
        • Harch P.G.
        • et al.
        Should the pressure be off or on in the use of oxygen in the treatment of carbon monoxide–poisoned patients?.
        Ann Emerg Med. 1994; 24: 283-288
        • Tibbles P.M.
        • Edelsberg J.S.
        Hyperbaric oxygen therapy.
        N Engl J Med. 1996; 334: 1642-1648
        • Geiderman J.M.
        • Ault M.J.
        Hyperbaric-oxygen therapy.
        N Engl J Med. 1996; 335 ([author reply: 1685–6]): 1684
        • Finnerty J.P.
        Hyperbaric oxygen for acute carbon monoxide poisoning.
        N Engl J Med. 2003; 348 ([author reply: 557–60]): 557-560
        • Rudge F.W.
        Carbon monoxide poisoning in infants: treatment with hyperbaric oxygen.
        South Med J. 1993; 86: 334-337
        • Margulies J.L.
        Acute carbon monoxide poisoning during pregnancy.
        Am J Emerg Med. 1986; 4: 516-519
        • Brown D.B.
        • Mueller G.L.
        • Golich F.C.
        Hyperbaric oxygen treatment for carbon monoxide poisoning in pregnancy: a case report.
        Aviat Space Environ Med. 1992; 63: 1011-1014
        • Hill E.P.
        • Hill J.R.
        • Power G.G.
        • et al.
        Carbon monoxide exchanges between the human fetus and mother: a mathematical model.
        Am J Physiol. 1977; 232: H311-H323
        • Gabb G.
        • Robin E.D.
        Hyperbaric oxygen. A therapy in search of diseases.
        Chest. 1987; 92: 1074-1082
        • Weaver L.K.
        • Hopkins R.O.
        • Elliott G.
        Carbon monoxide poisoning.
        N Engl J Med. 1999; 340 ([author reply: 1292]): 1290
        • Hampson N.B.
        • Simonson S.G.
        • Kramer C.C.
        • et al.
        Central nervous system oxygen toxicity during hyperbaric treatment of patients with carbon monoxide poisoning.
        Undersea Hyperb Med. 1996; 23: 215-219
        • Sloan E.P.
        • Murphy D.G.
        • Hart R.
        • et al.
        Complications and protocol considerations in carbon monoxide–poisoned patients who require hyperbaric oxygen therapy: report from a ten-year experience.
        Ann Emerg Med. 1989; 18: 629-634
        • Pierce II, E.C.
        • Zacharias A.
        • Alday Jr., J.M.
        • et al.
        Carbon monoxide poisoning: experimental hypothermic and hyperbaric studies.
        Surgery. 1972; 72: 229-237
        • Vossberg B.
        • Skolnick J.
        The role of catalytic converters in automobile carbon monoxide poisoning: a case report.
        Chest. 1999; 115: 580-581
        • Yoon S.S.
        • Macdonald S.C.
        • Parrish R.G.
        Deaths from unintentional carbon monoxide poisoning and potential for prevention with carbon monoxide detectors.
        JAMA. 1998; 279: 685-687