What organ besides the brain is most at risk for injury from Carbon Monoxide Poisoning?
November 29, 2024
Every year, the TPC has multiple cases of Carbon Monoxide poisoning with the arrival of cold weather. While the brain is often discussed as at risk of injury from Carbon Monoxide, the heart is also at high risk of injury as both organs are oxygen-dependent. The mechanisms of cardiovascular injury are not fully elucidated but may include a combination of direct hypoxia, vasodilation, carbon monoxide binding to myoglobin, and/or disruption of physiologic CO function (there is normal endogenous CO production from heme catabolism). (1) Clinical sequelae include “cardiomyopathy, arrhythmia, infarction, and cardiogenic shock.” (2) It is still not clear whether hyperbaric oxygen would be helpful in cases of myocardial toxicity and the literature is still not clear on indications for hyperbaric oxygen in general. There is also concern about the possibility that Carbon Monoxide could raise the risk for congestive heart failure, atherosclerosis, and “long-term mortality” and therefore, it is important to ensure those poisoned with it have primary care follow up. (2,3) It is unknown the window of development of delayed cardiac effects, but one study of China showed an effect for 2 years. (3)
Carbon monoxide is a silent killer and is odorless, colorless, and tasteless. Symptoms include vomiting, headache, body aches, fatigue, weakness, chest pain, dizziness, shortness of breath, palpitations, syncope, coma. Often multiple family members and pets are affected and therefore, it is important to think of Carbon Monoxide if multiple household members and/or pets present with the symptoms above. Treatment is with oxygen therapy often with a 100% non-rebreather mask and in select cases, hyperbaric oxygen therapy.
Just a friendly reminder to all as we see the cold weather move in to ensure that all homes have carbon monoxide detectors. Per the EPA “Each floor of the home needs a separate detector. If you are getting a single carbon monoxide detector, place it near the sleeping areas and make certain the alarm is loud enough to wake you up.” (4) Furthermore, it is important to never run a generator inside a home including a garage or basement and generators must be run 25 feet from the home with the vent pointed away from the home. It is also important to not run barbeques or grills, propane or kerosene heaters, or use an oven to heat indoor spaces.
Please do not hesitate to call the Tennessee Poison Center at 1-800-222-1222 with any questions regarding Carbon Monoxide Poisoning. We are available 24/7/365 including all holidays.
Rebecca Bruccoleri, MD
Medical Director
Tennessee Poison Center
References:
1. Gandini, C., Castoldi, A. F., Candura, S. M., Locatelli, C., Butera, R., Priori, S., & Manzo, L. (2001). Carbon Monoxide Cardiotoxicity. Journal of Toxicology: Clinical Toxicology, 39(1), 35–44. https://doi.org/10.1081/CLT-100102878
2. Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624
3. Huang CC, Chen TH, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Chang CP, Guo HR. Increased Risk of Congestive Heart Failure Following Carbon Monoxide Poisoning. Circ Heart Fail. 2021 Apr;14(4):e007267. doi: 10.1161/CIRCHEARTFAILURE.120.007267. Epub 2021 Apr 19. PMID: 33866825.
4. Environmental Protection Agency. “Where should I place a Carbon Monoxide Detector.” Available: Where should I place a carbon monoxide detector? | US EPA Accessed November 29, 2024.