Carbon Monoxide Poisoning in Kuwait: A Five-Year, Retrospective, Epidemiological Study

Background: Carbon monoxide (CO) poisoning is a major public health concern and a common cause of death worldwide. However, to our knowledge, no studies have been conducted on CO poisoning exposure and mortality in Kuwait. Objectives: Using epidemiological and forensic data analysis, we investigated the prevalence and characteristics of CO poisoning-associated deaths in Kuwait over five years (2014–2018), using official police data. Methods: The Forensic Toxicology Laboratory analyzed 203 blood specimens of deceased individuals for potential CO poisoning during the study period. We obtained demographic information of the deceased and other information regarding the source of the CO, the type of death and the seasonal and geographical distribution of fatalities. The percentage of carboxyhemoglobin (COHb%) was assessed using a CO-oximeter. Results: CO poisoning was confirmed in ~29% (59 cases) of the analyzed specimens, of which CO poisoning was accidental in the majority of cases (~95%) and homicidal in the remaining of cases (~5%), with no reported suicides. The five-year cumulative mean of COHb% in the blood specimens of the 59 confirmed cases was ~63%. Most of the deceased were males (~68%). The mean age of male and female victims per year were similar (~23–38 years). Fatalities were more common (~44%) during the winter (December–February). Uncontrolled home fires and coal stoves contributed to the primary sources of CO poisoning at 61% and 22%, respectively. Recommendations: Based on our findings, we propose that the local government should mandate the installation of smoke alarms and CO detectors in residential settings and endorse health education, informing the local population about the causes of fire and potential for CO poisoning, with an emphasis on prevention. Practical measures that can be applied include proper installation and regular maintenance of home-heating appliances and appropriate ventilation. The present study could greatly benefit the government in directing efforts toward decreasing CO poisoning incidents in Kuwait in the future.

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Predictive Role of QTc Prolongation in Carbon Monoxide Poisoning-Related Delayed Neuropsychiatric Sequelae

BioMed Research International ◽

10.1155/2018/2543018 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Shu-Chen Liao ◽

Yan-Chiao Mao ◽

Yao-Min Hung ◽

Ching-Hsing Lee ◽

Chen-Chang Yang

Keyword(s):

Carbon Monoxide ◽

Roc Curve ◽

Carbon Monoxide Poisoning ◽

Chang Gung Memorial Hospital ◽

Qtc Interval ◽

Continuous Variables ◽

Co Poisoning ◽

Qtc Prolongation ◽

Roc Curve Analysis ◽

Delayed Neuropsychiatric Sequelae

Objective. Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients’ quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. Methods. This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. Results. A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21–6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31–9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03–1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21–5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660–0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. Conclusions. We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning.

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Brain stem and spinal cord demyelination due to acute carbon monoxide poisoning

Undersea and Hyperbaric Medicine ◽

10.22462/05.06.2021.5 ◽

2021 ◽

pp. 247-253

Author(s):

Yan Lv ◽

Yv Zhang ◽

Shuyi Pam ◽

Keyword(s):

Spinal Cord ◽

Carbon Monoxide ◽

Brain Stem ◽

Carbon Monoxide Poisoning ◽

Recovery Period ◽

Extended Period ◽

Severe Case ◽

Co Poisoning ◽

Secondary Demyelination ◽

The Brain

Demyelination throughout the brain stem and spinal cord caused by acute carbon monoxide (CO) poisoning has not been previously reported. Magnetic resonance imaging (MRI) has revealed that acute CO poisoning primarily affects the subcortical white matter of the bilateral cerebral hemispheres and basal ganglia. Here we report the case of a patient with delayed neuropsychological sequelae (DNS) due to acute CO poisoning. A 28-year-old man was admitted to our department following a suicide attempt by acute CO poisoning. After a six-month pseudo-recovery period, he was diagnosed with DNS, with MRI evidence of demyelinating change of the bilateral cerebral peduncles. Demyelination was identified throughout the brain stem, expanding from the bilateral cerebral peduncles to the medulla oblongata, occurring approximately six months after poisoning. One and a half years after acute CO poisoning, demyelination of the cervical and thoracic spine was observed, most notable in the lateral and posterior cords. It is evident that previously published research on this topic is extremely limited. Perhaps in severe cases of acute CO poisoning the fatality rate is higher, leading to fewer surviving cases for possible study. This may be because a more severe case of acute CO poisoning would result in the higher likelihood of secondary demyelination. This research indicates that clinicians should be aware of the risk of secondary demyelination and take increased precautions such as vitamin B supplementation and administration of low-dose corticosteroids for an extended period of time in order to reduce the extent and severity of demyelination.

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Epidemiological aspects and a current approach to the problem of carbon monoxide poisoning

Russian Journal of Forensic Medicine ◽

10.19048/fm344 ◽

2020 ◽

Vol 6 (4) ◽

pp. 4-9

Author(s):

Sayit I. Indiaminov ◽

Antonina A. Kim

Keyword(s):

Carbon Monoxide ◽

World Literature ◽

Carbon Monoxide Poisoning ◽

Epidemiological Data ◽

Current Approach ◽

Co Poisoning ◽

Fatal Poisoning ◽

Young Males ◽

Causes Of Mortality ◽

Mechanical Asphyxia

Background: Carbon monoxide (CO) poisoning is the leading cause of death from poisoning (accidental and intentional). The number of cases of CO poisoning is increasing day by day. Aims: The aim of the study was to analyze the epidemiological situation of CO poisoning and identify the urgent aspects of this problem. In the article, the author provided a retrospective analysis of 117 cases of CO poisoning, registered in a number of regional branches of the Republican Scientific and Practical Center of the Forensic Medical Examination of Uzbekistan, after he studied and analyzed the world literature on the epidemiology of CO poisoning. It has been revealed that fatal poisoning ranks third after mechanical injuries and mechanical asphyxia and constitutes 6.3% (513 cases) in the range of deaths by violence (8078 cases). Therefore, CO poisoning is considered as one of the most prevailing (51%) causes of mortality. Conclusion: This is a global problem, with young males at risk. Further studies on the current clinical and forensic aspects of CO poisoning are required, and the necessity for regular analysis of epidemiological data for taking comprehensive measures to prevent CO poisoning is emphasized.

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Carbon Monoxide Poisoning Effectively Treated with High-flow Nasal Cannula

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.9.43618 ◽

2019 ◽

Vol 4 (1) ◽

pp. 42-45

Author(s):

Patrick Lee ◽

Steven Salhanick

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

High Flow ◽

Nasal Cannula ◽

The Novel ◽

Co Poisoning ◽

High Flow Nasal Cannula ◽

Disease States ◽

Cohb Level ◽

Potential Option

Carbon monoxide (CO) poisoning is typically treated by administration of oxygen via non-rebreather mask (NRB). High-flow nasal cannula (HFNC) is an alternative to NRB in a variety of disease states. We report a case of the novel use of HFNC in the treatment of acute CO poisoning. A 29-year-old man presented with a carboxyhemoglobin (COHb) level of 29.8%. He was treated with HFNC, and COHb levels declined to 5.4% in 230 minutes. Given several theoretical advantages of HFNC relative to NRB, HFNC is a potential option for use in the treatment of CO poisoning.

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Evaluation of oxidative stress and antioxidant parameters in children with carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/0960327119867751 ◽

2019 ◽

Vol 38 (11) ◽

pp. 1235-1243

Author(s):

O Teksam ◽

S Sabuncuoğlu ◽

G Girgin ◽

H Özgüneş

Keyword(s):

Oxidative Stress ◽

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Venous Blood ◽

Treatment Modalities ◽

Control Group ◽

Co Poisoning ◽

Erythrocyte Catalase ◽

Significant Difference ◽

Before And After

Objective: In this study, we aimed to investigate oxidative stress and antioxidant parameter levels in patients with carbon monoxide (CO) poisoning. Methods: The study was conducted prospectively between March 1, 2015 and April 30, 2016 in the pediatric emergency department. Eligible patients included children aged 0–18 years old with a diagnosis of CO poisoning. To determination of oxidative stress and antioxidant parameter levels, venous blood with heparinized and urine samples were drawn during the admission and after normobaric oxygen (NBO) and hyperbaric oxygen (HBO) treatment. Results: Forty-seven children with CO poisoning for study group and 29 patients as control group were included to the study. Sixteen patients treated with HBO. Basal plasma malondialdehyde levels were found to be significantly higher in the CO poisoning group when compared with the control group ( p = 0.019). There is no significant difference in oxidative stress and antioxidant parameter levels except erythrocyte catalase enzyme levels in patients treated with NBO when comparing before and after NBO treatment ( p > 0.05). Decreasing of basal erythrocyte catalase enzyme levels were found statistically significant after NBO treatment ( p = 0.04). There was no significant difference in oxidative stress and antioxidant parameter levels in patients treated with HBO before and after therapy ( p > 0.05). Conclusions: CO poisoning is associated with increased lipid peroxidation in children immediately after the poisoning. However, both treatment modalities including NBO or HBO do not have a significant effect on oxidative stress or antioxidant parameter levels.

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Storm-Related Carbon Monoxide Poisoning

Social Marketing Quarterly ◽

10.1177/1524500413493426 ◽

2013 ◽

Vol 19 (3) ◽

pp. 188-199 ◽

Cited By ~ 5

Author(s):

Scott A. Damon ◽

Jon A. Poehlman ◽

Douglas J. Rupert ◽

Peyton N. Williams

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

The United States ◽

Attitudes And Beliefs ◽

Matrix Approach ◽

Co Poisoning ◽

Protective Behaviors ◽

Home Safety ◽

Severe Storms ◽

Summer Storm

Carbon monoxide (CO) poisonings in the United States consistently occur when residents improperly use portable gasoline-powered generators and other tools following severe storms and power outages. However, protective behaviors—such as installing CO alarms and placing generators more than 20 feet away from indoor structures—can prevent these poisonings. This study identified knowledge, attitudes, and beliefs that lead consumers to adopt risk and protective behaviors for storm-related CO poisoning and post-storm generator use. Four focus groups (32 participants in total) were conducted with generator owners in winter and summer storm-prone areas to explore home safety, portable generator use, CO poisoning knowledge, and generator safety messages. Discussions were transcribed, and findings analyzed using an ordered meta-matrix approach. Although most generator owners were aware of CO poisoning, many were unsure what constitutes a safe location for generator operation and incorrectly stated that enclosed areas outside the home—such as attached garages, sheds, and covered porches—were safe. Convenience and access to appliances often dictated generator placement. Participants were receptive to installing CO alarms in their homes but were unsure where to place them. These findings suggest a deficit in understanding how to operate portable generators safely and a need to correct misconceptions around safe placement. In terms of behavioral price, the simple installation and maintenance of inexpensive CO alarms may be the most important strategy for ultimately protecting homes from both storm-related and other CO exposures.

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Carbon Monoxide Poisoning: Implications for Patient and Family Care in the Emergency Department

Clinical Scholars Review ◽

10.1891/1939-2095.1.1.46 ◽

2008 ◽

Vol 1 (1) ◽

pp. 46-49 ◽

Cited By ~ 1

Author(s):

Courtney E. Reinisch

Keyword(s):

Emergency Department ◽

Carbon Monoxide ◽

Practice Nurse ◽

Early Recognition ◽

Carbon Monoxide Poisoning ◽

Family Care ◽

The United States ◽

Emergency Department Visits ◽

Advanced Practice ◽

Co Poisoning

Carbon monoxide (CO) is a colorless, odorless gas that can produce a constellation of noxious symptoms and potentially death when it reaches certain levels. Exposure to CO can be intentional (suicidal) or unintentional (accidental). CO poisoning is responsible for up to 40,000 to 50,000 emergency department visits and 5,000 to 6,000 deaths per year, making it one of the leading causes of poisoning death in the United States. When patients present to the emergency department with a constellation of symptoms, the advanced practice nurse should include environmental exposure in the differential diagnosis. This is especially important when family members present with similar complaints, such as headache or euphoria. Early recognition of CO poisoning is vital to identify individuals in need of prompt treatment and to prevent harmful and potential deadly exposure to others. Since patients often present with constitutional symptoms, including headache (most common), malaise, nausea, and dizziness, providers need to be cautious not to misdiagnose patients as having acute viral syndromes where CO poisoning could be the cause. Vigilance is needed during the winter months in cold climates when unintended poisoning is most common.

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Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/0960327117698544 ◽

2017 ◽

Vol 37 (3) ◽

pp. 240-246 ◽

Cited By ~ 4

Author(s):

YS Cha ◽

H Kim ◽

HH Do ◽

HI Kim ◽

OH Kim ◽

...

Keyword(s):

Carbon Monoxide ◽

Troponin I ◽

Carbon Monoxide Poisoning ◽

Neuropsychiatric Symptoms ◽

Neuron Specific Enolase ◽

Additional Parameter ◽

Co Poisoning ◽

Early Predictors ◽

Delayed Neuropsychiatric Sequelae ◽

Serum Neuron Specific Enolase

Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). To date, there have been no studies on the utility of serum neuron-specific enolase (NSE), a marker of neuronal cell damage, as a predictive marker of DNS in acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 9-month period. Serum NSE was measured after emergency department arrival, and patients were divided into two groups. The DNS group comprised patients with delayed sequelae, while the non-DNS group included patients with none of these sequelae. A total of 98 patients with acute CO poisoning were enrolled in this study. DNS developed in eight patients. The median NSE value was significantly higher in the DNS group than in the non-DNS group. There was a statistical difference between the non-DNS group and the DNS group in terms of CO exposure time, Glasgow Coma Scale (GCS), loss of consciousness, creatinine kinase, and troponin I. GCS and NSE were the early predictors of development of DNS. The area under the curve according to the receiver operating characteristic curves of GCS, serum NSE, and GCS combined with serum NSE were 0.922, 0.836, and 0.969, respectively. In conclusion, initial GCS and NSE served as early predictors of development of DNS. Also, NSE might be a useful additional parameter that could improve the prediction accuracy of initial GCS.

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Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning

Scientific Reports ◽

10.1038/s41598-021-98539-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shu-Chen Liao ◽

Shih-Chieh Shao ◽

Kun-Ju Yang ◽

Chen-Chang Yang

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Real World ◽

Roc Curve ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Carbon Monoxide Poisoning ◽

Chang Gung Memorial Hospital ◽

Co Poisoning ◽

Delayed Neuropsychiatric Sequelae

AbstractTo assess real-world effectiveness of hyperbaric oxygen therapy (HBOT) on delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning we conducted a retrospective review of patients with CO poisoning admitted to Linkou Chang-Gung Memorial Hospital, Taiwan’s largest medical center, during 2009–2015. We included patients developing DNS after CO poisoning and compared improvements in neuropsychiatric function, with and without HBOT, after 12 months post-DNS to understand differences in recovery rates. DNS improvement-associated factors were also evaluated. We used receiver operating characteristic (ROC) curve analysis to assess the role of time elapsed between DNS diagnosis and HBOT initiation in predicting DNS improvement. A total of 62 patients developed DNS, of whom 11 recovered while the rest did not. Possible factors predicting DNS improvement included receiving HBOT post-DNS (72.7% vs 25.5%; P = 0.006), and treatment with more than three HBOT sessions during acute stage CO poisoning (81.8% vs 27.5%; P = 0.003). The relevant area under the ROC curve was 0.789 (95% CI 0.603–0.974), and the best cut-off point was 3 days post-DNS diagnosis, with 87.5% sensitivity and 61.5% specificity. Early HBOT in patients who developed DNS after CO poisoning significantly improved their DNS symptoms, with treatment effects sustained for 1 year after DNS diagnosis.

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COVID-19 morbidity and mortality caused by endogenous carbon monoxide poisoning, with recommendations for testing and treatment

10.31219/osf.io/uvj42 ◽

2020 ◽

Author(s):

Albert Hamburger Donnay

Keyword(s):

Carbon Monoxide ◽

Oxygen Saturation ◽

Carbon Monoxide Poisoning ◽

Cardiac Injury ◽

Case Series ◽

Body Burden ◽

Morbidity And Mortality ◽

Heme Oxygenase 1 ◽

Co Poisoning ◽

Blood Tests

To test our hypothesis that abnormal levels of endogenous carbon monoxide (CO) produced naturally by heme oxygenase-1 (HO-1) in response to infections of all kinds may be contributing to the morbidity and mortality associated with COVID-19, we searched PubMed for peer-reviewed literature on carbon monoxide and each of eleven abnormal blood tests, fourteen signs and symptoms, and five fatal complications of COVID-19 infection reported in a case series from a hospital in Wuhan, China: acute respiratory distress syndrome (ARDS), acute kidney injury, acute cardiac injury, arrhythmia, and shock. We found reports of acute exogenous CO poisoning causing all the same signs, symptoms and complications, and all the abnormal blood tests except D-dimer and procalcitonin. Our search also found endogenous HO-1 and CO levels correlated with these complications, independent of any inhaled CO exposure. In sharp contrast to the CO poisoning literature, most studies of endogenous CO interpret its close positive correlation with these acute conditions as protective, with some going so far as to recommend treating ARDS with inhaled CO. We conclude with new recommendations for testing endogenous CO poisoning in COVID-19 cases using devices approved by the US Food and Drug Administration that can distinguish CO coming from the lungs, arteries, veins, and average of all tissues, unlike current protocols for CO poisoning that only measure CO in arteries or veins but not both. Based on these findings, we appeal to clinicians to start testing CO levels in COVID-19 patients and to stop monitoring oxygen saturation with conventional pulse oximeters that overestimate oxygen saturation by the sum of carboxyhemoglobin and methemoglobin. We conclude by reviewing FDA-approved treatments that may help COVID-19 patients with endogenous CO poisoning. These include zinc-based drugs that lower the rate of endogenous CO production by inhibiting HO-1, and drug-free devices and methods that reduce the total body burden of CO after exogenous CO poisoning.

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