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Carbon Monoxide

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Carbon monoxide is a colorless and odorless gas that is generated by incomplete combustion. Inside homes, it can be generated from improperly adjusted gas appliances, wood burning stoves, and furnaces. Carbon monoxide has an affinity for blood cells and prevents oxygenation of the blood resulting in difficulty breathing and stress on the cardiovascular system. Carbon monoxide can be lethal at high concentrations, but even at lower concentrations it can affect the brain and cardiovascular system leading to a condition referred to as anoxia. Breathing even low levels of carbon monoxide during pregnancy can lead to anoxia resulting in miscarriage or effects on the mental development of a child. Dr. Parent has addressed these issues in litigation and has developed pertinent references on the subject that are provided below.

Selected References

Aslan, S., Uzkeser, M., Seven, B., Gundogdu, F., Acemoglu, H., Aksakal, E. and Varoglu, E., The evaluation of myocardial damage in 83 young adults with carbon monoxide poisoning in the East Anatolia region in Turkey. Human and Experimental Toxicology, 25(8), 439-446 (2006).

Battley, J. C. S., Chronic carbon monoxide poisoning. Canadian Medical Association Journal, 19(2), 157-163 (1928).

Benowitz, N. L., Cardiotoxicity in the workplace. Occupational Medicine, 7(3), 465-478 (1992).

Birkenhager-Gillesse, E. G. and van der Poel, M. F., Carbon monoxide poisoning; psychotic depression brought on by a new kitchen. Tijdschrift Voor Psychiatrie, 50(4), 235-239 (2008).

Caplan, Y. H., Thompson, B. C., Levine, B. and Masemore, W., Accidental poisonings involving carbon monoxide, heating systems and confined spaces. Journal of Forensic Sciences, 31(1), 117-121 (1986).

Chace, D. H., Goldbaum, L. R. and Lappas, N. T., Factors affecting the loss of carbon monoxide from stored blood samples. Journal of Analytical Toxicology, 10(5), 181-189 (1986).

Cobb, N. and Etzel, R. A., Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988. Journal of the American Medical Association, 266(5), 659-663 (1991).

Devine, S. A., Kirkley, S. M., Palumbo, C. L. and White, R. F., MRI and neuropsychological correlates of carbon monoxide exposure: a case report. Environmental Health Perspectives, 110(10), 1051-1055 (2002).

Dubowski, K. M. and Luke, J. L., Measurement of carboxyhemoglobin and carbon monoxide in blood. Annals of Clinical Laboratory Science, 3(1), 53-65 (1973).

Durak, A. C., Coskun, A., Yikilmaz, A., Erdogan, F., Mavili, E. and Guven, M., Magnetic resonance imaging findings in chronic carbon monoxide intoxication. Acta Radiologica, 46(3), 322-327 (2005).

Ellenhorn, M. J. and Barceloux, D. G., Carbon monoxide.  In:  Medical Toxicology - Diagnosis and Treatment of Human Poisoning. Elsevier Science Publishing Co., Inc., New York, New York, 823-824 (1988).

Ettema, J. H., Zielhuis, R. L., Burer, E., Meier, H. A., Kleerekoper, L. and DeGraff, M. A., Effects of alcohol, carbon monoxide and trichloroethylene exposure on mental capacity. International Archives of Occupational and Environmental Health, 35, 117-132 (1975).

Goldbaum, L. R., Schloegel, E. L. and Dominguez, A. M., Application of gas chromatography to toxicology.  In: Progress in Chemical Toxicology. Volume 1. Stohman, A. (ed). Academic Press, New York, 11-52 (1963).

Haaxma, C. A., van Eijk, J. J., van der Vilet, A. M., Renier, W. O. and Bloem, B. R., Bilateral lesions of the basal ganglia as a sign of chronic carbon monoxide intoxication. Nederlands Tijdschrift Voor Geneeskunde, 151(15), 868-873 (2007).

Heimbach, D. M. and Waeckerle, J. F., Inhalation injuries. Annals of Emergency Medicine, 17(12), 1316-1320 (1988).

Henry, C. R., Satran, D., Lindgren, B., Adkinson, C., Nicholson, C. I. and Henry, T. D.,
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Hinderliter, A. L., Adams, Jr., K. F., Price, C. J., Herbst, M. C., Koch, G. and Sheps, D. S., Effects of low-level carbon monoxide exposure on resting and exercise-induced ventricular arrhythmias in patients with coronary artery disease and no baseline ectopy. Archives of Environmental Health, 44(2), 89-93 (1989).

Hopkins, R. O. and Woon, F. L., Neuroimaging, cognitive, and neurobehavioral outcomes following carbon monoxide poisoning. Behavioral and Cognitive Neuroscience Reviews, 5(3), 141-155 (2006).  [CTX-039282]

Iastrebov, V. E., [Assessment of the carbon monoxide content in the body in aviation accidents]. Sudebno-Meditsinskaia Ekspertiza, 28(4), 41-43 (1985).

Iffland, R., Balling, P. and Eiling, G., Optimizing carbon monoxide detection in biological material. Beitrage zur Gerichtlichen Medizin, 47, 87-94 (1989).

Iffland, R., Madea, B. and Balling, P., [Diagnosis of carbon monoxide poisoning following embalming and exhumation]. Archiv fur Kriminologie, 182(3-4), 100-106 (1988).

Kao, L. W. and Nanagas, K. A., Carbon monoxide poisoning. Emergency Medicine Clinics of North America, 22, 985-1018 (2004).

Kelafant, G. A., Encephalopathy and peripheral neuropathy following carbon monoxide poisoning from a propane-fueled vehicle. American Journal of Industrial Medicine, 30(6), 765-768 (1996).

Kirkpatrick, J. N., Occult carbon monoxide poisoning. Western Journal of Medicine, 146(1), 52-56 (1987).

Klette, K., Levine, B., Springate, C. and Smith, M. L., Toxicological findings in military aircraft fatalities from 1986-1990. Forensic Science International, 53(2), 143-148 (1992).

Kloppel, A. and Weiler, G., Putrefaction-induced changes in the concentration and temporal detectibility of carbon monoxide in cadaveric blood samples. Zeitschrift fur Rechtsmedizin, 97(2), 105-109 (1986).

Knobeloch, L. and Jackson, R., Recognition of chronic carbon monoxide poisoning. Wisconsin Medical Journal, 98(6), 26-29 (1999).

Kojima, T., Yashiki, M., Chikasue, F. and Miyazaki, T., Analysis of inflammable substances to determine whether death has occurred before or after burning. Zeitschrift fur Rechtsmedizin, 103(8), 613-619 (1990).

Kojima, T., Okamoto, I., Yashiki, M., Miyazaki, T., Chikasue, F., Degawa, K., Oshida, S. and Sagisaka, K., Production of carbon monoxide in cadavers. Forensic Science International, 32(2), 67-77 (1986).

Kojima, T., Yashiki, M. and Une, I., Experimental study on postmortem formation of carbon monoxide. Forensic Science International, 22(2-3), 131-135 (1983).

Kojima, T., Nishiyama, Y., Yashiki, M. and Une, I., Postmortem formation of carbon monoxide. Forensic Science International, 19(3), 243-248 (1982).

Lightfoot, N. F., Chronic carbon monoxide exposure. Proceedings of the Royal Society of Medicine, 65(9), 798-799 (1972).

Maeda, H., Fukita, K., Oritani, S., Ishida, K. and Zhu, B. L., Evaluation of post-mortem oxymetry with reference to the causes of death. Forensic Science International, 87(3), 201-210 (1997).

Melin, A., Bonnet, P., Eder, V., Antier, D., Obert, P. and Fauchier, L., Direct implication of carbon monoxide in the development of heart failure in rats with cardiac hypertrophy subjected to air pollution. Cardiovascular Toxicology, 5(3), 311-320 (2005).

Meredith, T. and Vale, A., Carbon monoxide poisoning. British Medical Journal (Clinical Research Edition), 296(6615), 77-79 (1988).

Middleberg, R. A., Easterling, D. E., Zelonis, S. F., Rieders, F. and Rieders, M. F., Estimation of perimortal percent carboxy-heme in nonstandard postmortem specimens using analysis of carbon monoxide by GC/MS and iron by flame atomic absorption spectrophotometry. Journal of Analytical Toxicology, 17(1), 11-13 (1993).

Mikov, I., Draskovic, D., Arsic, M., Todorovski, Z. and Glavaski, M., Occupational intoxication with carbon monoxide. Archives of Environmental Health, 55(6), 455-456 (2000).

Myers, R. A., Linberg, S. E. and Cowley, R. A., Carbon monoxide poisoning: the injury and its treatment. Journal of the American College of Emergency Physicians, 8(11), 479-484 (1979).

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Prockop, L. D., Carbon monoxide brain toxicity: clinical, magnetic resonance imaging, magnetic resonance spectroscopy, and neuropsychological effects in 9 people. Journal of Neuroimaging, 15(2), 144-149 (2005).

Rai, V. S. and Minty, P. S., The determination of carboxyhaemoglobin in the presence of sulphaemoglobin. Forensic Science International, 33(1), 1-6 (1987).

Raub, J. A., Mathieu-Nolf, M., Hampson, N. B. and Thom, S. R., Carbon monoxide poisoning-a public health perspective. Toxicology, 145(1), 1-14 (2000).

Reynolds, Jr., N. C. and Shapiro, I., Retrobulbar neuritis with neuroretinal edema as a delayed manifestation of carbon monoxide poisoning: case report. Military Medicine, 144(7), 472-473 (1979).

Rodkey, F. L., O'Neal, J. D., Collison, H. A. and Uddin, D. E., Relative affinity of hemoglobin S and hemoglobin A for carbon monoxide and oxygen. Clinical Chemistry, 20(1), 83-84 (1974).

Rosenthal, L. D., Carbon monoxide poisoning. Immediate diagnosis and treatment are crucial to avoid complications. American Journal of Nursing, 106(3), 40-46; 46-47 (2006).

Ryan, C. M., Memory disturbances following chronic, low-level carbon monoxide exposure. Archives of Clinical Neuropsychology, 5(1), 59-67 (1990).

Sari, I., Zengin, S., Ozer, O., Davutoglu, V., Yildirim, C. and Aksoy, M., Chronic carbon monoxide exposure increases electrocardiographic P-wave and QT dispersion. Inhaltion Toxicology, 20(9), 879-884 (2008).

Satran, D., Henry, C. R., Adkinson, C., Nicholson, C. I., Bracha, Y. and Henry, T. D., Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. Journal of the American College of Cardiology, 45(9), 1513-1516 (2005).

Shapiro, A. B., Maturen, A., Herman, G., Hryhorczuk, D. O. and Leikin, J. B., Carbon monoxide and myonecrosis: a prospective study. Veterinary and Human Toxicology, 31(2), 136-137 (1989).

Siek, T. J. and Rieders, F., Determination of carboxyhemoglobin in the presence of other blood hemoglobin pigments by visible spectrophotometry. Journal of Forensic Sciences, 29(1), 39-54 (1984).

Sorhaug, S., Steinshamn, S., Nilsen, O. G. and Waldum, H. L., Chronic inhalation of carbon monoxide: effects on the respiratory and cardiovascular system at doses corresponding to tobacco smoking. Toxicology, 228(2-3), 280-290 (2006).

Sullivan, Jr., J. B., Van Ert, M., In:  Hazardous Materials Toxicology, Clinical Principles of  Environmental Health. Sullivan, Jr., J. B. and Krieger, G. R., (eds). Williams and Wilkins, Baltimore, Maryland, 595 (1992).

Tietz, N. W. and Fiereck, E. A., The spectrophotometric measurement of carboxyhemoglobin. Annals of Clinical and Laboratory Science, 3, 36-42 (1973).

US Environmental Protection Agency (US EPA), Integrated science assessment for carbon monoxide - first external review draft. US Environmental Protection Agency (US EPA), National Center for Environmental Assessment, Office of Research and Development, Research Triangle Park, NC, EPA/600/R-09/019, 494 pages, March (2009).

Varon, J. and Marik, P., Carbon monoxide poisoning. Online resource, The Internet Journal of Emergency and Intensive Care Medicine, Volume 1, Number 2,,  accessed February, 2009.

Vyskocil, A., Tusl, M. and Zaydlar, K., The effect of chronic exposure to 100 ppm carbon monoxide on brain biomines, serum corticosterone and organ weights in rats. Journal of Applied Toxicology, 3(6), 307-309 (1983).

Winek, C. L., Esposito, F. M. and Cinicola, D. P., The stability of several compounds in formalin fixed tissues and formalin-blood solutions. Forensic Science International, 44(2-3), 159-168 (1990).

Winek, C.. L. and Prex, D. M., A comparative study of analytical methods to determine postmortem changes in carbon monoxide concentration. Forensic Science International, 18(2), 181-187 (1981).

Wolf, M. and Weller, J. P., [A simple procedure for CO detection in blood using micro-headspace gas chromatography]. Beitrage Zur Gerichtlichen Medizin, 45, 395-398 (1987).

Wright, J., Chronic and occult carbon monoxide poisoning: we don't know what
we're missing. Emergency Medicine Journal, 19(5), 386-390 (2002).

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