What you need to know about carbon monoxide What you need to know about the leading cause of poisoning deaths in America Carbon Monoxide The following text is from the booklet What you need to know about the leading cause of poisoning deaths in America: Carbon monoxide (1996), prepared as a public service by First Alert in cooperation with the Cooperative State Research, Education, and Extension Service (CSREES) of the U.S. Department of Agriculture. If you have questions about carbon monoxide, contact your local gas utility, a qualified heating contractor, or the Extension Services office listed in the white pages of your phone book. What is carbon monoxide and who is at risk? Carbon monoxide (CO) is a colorless, odorless deadly gas. Because you can't see, taste, or smell it, carbon monoxide can kill you before you know it's there. Everyone is at risk for carbon monoxide poisoning. Experts believe, however, that individuals with greater oxygen requirements such as unborn babies, infants, children, senior citizens, and people with coronary or respiratory problems are at greater risk. Why is carbon monoxide so dangerous? The great danger of carbon monoxide is its attraction to hemoglobin in the bloodstream.

When breathed in, carbon monoxide replaces the oxygen which cells need to function. When CO is present in the air, it rapidly accumulates in the blood, causing symptoms similar to the flu, such as headaches, fatigue, nausea, dizzy spells, confusion, and irritability. As levels increase, vomiting, loss of consciousness, and eventually brain damage or death can result. Where does carbon monoxide come from? Carbon monoxide is a by-product of combustion, present whenever fuel is burned. It is produced by common home appliances, such as gas or oil furnaces, gas refrigerators, gas clothes dryers, gas ranges, gas water heaters or space heaters, fireplaces, charcoal grills, and wood burning stoves. Fumes from automobiles and gas-powered lawn mowers also contain carbon monoxide and can enter a home through walls or doorways if an engine is left running in an attached garage. All of these sources can contribute to a CO problem in the home. If a home is vented properly and is free from appliance malfunctions, air pressure fluctuations or airway blockages, carbon monoxide will most likely be safely vented to the outside. But in today's "energy efficient" homes this is frequently not the case.

Tightly constructed/sealed homes can trap CO-polluted air in a home year-round. Furnace heat exchangers can crack, vents can become blocked, inadequate air supply for combustion appliances can cause conditions known as backdrafting or reverse stacking, which force contaminated air back into the home. Exhaust fans on range hoods, clothes dryers and bathroom fans can also pull combustion products into the home. How can I protect myself and my family from carbon monoxide poisoning? The Consumer Product Safety Commission (CPSC) recommends installing at least one carbon monoxide detector per household, near the sleeping area. Additional detectors on every level of a home and in every bedroom provide extra protection. Choose an Underwriters Laboratories Inc. (UL) listed detector that sounds an audible alarm. You can choose a model that is wired to your home's electrical system, a model which plugs into a standard electrical outlet, or a battery-operated model. Battery-operated carbon monoxide detectors continue to protect even in the event of a power outage. Hardwired AC models, although more costly and difficult to install, reduce the expense of battery replacement but do not offer protection during power outages. Hardwired AC models with battery back-up offer double protection.

Gas appliances should be serviced yearly by a qualified service technician. Stove burners should be cleaned and adjusted to minimize the amount of carbon monoxide produced. Before making changes to a house that might affect the ventilation of fuel-burning appliances, contact your heating contractor. When replacing heating appliances, purchase appliances designed to reduce dangers from carbon monoxide, such as sealed combustion gas furnaces, direct vent gas fireplaces, or induced draft gas water heaters. Electric-powered heating appliances do not produce carbon monoxide. If your carbon monoxide detector sounds, first make sure it is your CO detector and not your smoke detector. The latest generation of carbon monoxide detectors listed with UL will be marked "carbon monoxide detector" in a contrasting color on the cover. Some detectors feature a warning alarm which will sound before the full (continuous) alarm. If your detector is in warning alarm, carbon monoxide is beginning to accumulate. It is important to locate and eliminate the source of CO before the condition worsens. A trained HVAC contractor or appliance service technician can inspect your home to determine the cause of carbon monoxide build-up. If your detector is in full alarm and any member of the household is experiencing symptoms of poisoning, call your local fire department immediately!

Remember that infants and children may be affected more quickly by carbon monoxide. Be sure to see if they are exhibiting symptoms. If no one is feeling symptoms, ventilate the home with fresh air, turn off all potential sources of carbon monoxide and have a qualified technician inspect your combustion appliances. In addition to installing carbon monoxide detectors, consumers should regularly inspect and service potential problem sources of carbon monoxide. Checklist -- Where to look for problem sources of carbon monoxide: Furnaces are frequently the source of leaks and should be carefully inspected. Have a professional check the following: Measure the concentration of CO in the flue gases. Check furnace connections to flue pipes and venting systems to outside of the home for signs of corrosion, rust, gaps, or holes. Check furnace filters and filtering systems for dirt or blockages. Check forced air fans for proper installation and correct air flow of flue gases. Improper furnace blower installation can result in carbon monoxide build-up because toxic gas is blown into rather than out of the house. Check the combustion chamber and internal heat exchanger for cracks, metal fatigue or corrosion--be sure they are clean and free of debris. Check burners and ignition system.

A flame that is mostly yellow in color in natural gas-fired furnaces is often a sign fuel is not burning completely and higher levels of carbon monoxide are being released. Oil furnaces with similar problems can give off an "oily" odor. Remember, you can't smell carbon monoxide. Check all venting systems to the outside, including flues and chimneys for proper design and installation, cracks, corrosion, holes, debris, or blockages. Animals and birds can build nests in chimneys, preventing gases from escaping. Check all other appliances that use flammable fuels such as natural gas, oil, wood, or kerosene. Appliances include water heaters, clothes dryers, kitchen ranges, ovens or cooktops, wood burning stoves, gas refrigerators. Pilot lights can be a source of carbon monoxide because the by-products of combustion are released inside the home rather than vented to the outside. Gas ovens and ranges should be monitored closely. Be sure space heaters are vented properly. Unvented space heaters that use a flammable fuel such as kerosene can release carbon monoxide into the home.

Barbecue grills should never be operated indoors, nor should stove tops or ovens that operate on flammable fuels ever be used to heat a residence. Check fireplaces for closed, blocked or bent flues, soot, and debris. Check the clothes dryer vent opening outside the house for lint. If initial testing does not confirm the presence of carbon monoxide, there may be several reasons. Testing equipment used to measure the presence of carbon monoxide in the air must be calibrated to sense low levels of gas concentration. Some detection devices only measure concentrations of 1,000 parts per million and higher, significantly above safe levels. Testing equipment should be capable of sensing levels as low as one part per million. For example, Underwriters Laboratories' standard for residential carbon monoxide detectors requires detectors to alarm before 90 minutes of exposure to 100 parts per million of carbon monoxide. If initial readings don't reveal sufficient concentrations of carbon monoxide to set off the alarm, digital measurement testing equipment that produces a printed 24-hour record can be used to help identify the source. If doors or windows are left open or appliances are turned off and outside air enters the home, carbon monoxide can dissipate.

This creates a lower reading than the level that triggered the alarm. To help assure proper measurement, carbon monoxide readings should be conducted as soon as possible after an alarm incident. If appliances, flues and chimneys are confirmed to be in good working order, the source of carbon monoxide leaks may be from backdrafting. This condition exists primarily in tightly sealed/constructed homes. Flue gases normally vent to the outside through flues and chimneys. Air pressure inside a tightly sealed home may become lower than outside, causing outside air to flow into the house through vents and chimneys. Inadequate air supply in a room where two or more combustion-driven appliances share the same air source, such as a water heater and furnace in a utility closet, can create a more complicated form of backdrafting called reverse stacking. This occurs when one appliance, such as the furnace, turns on and is unable to get adequate fresh air. When the furnace operates, it then draws contaminated air from the water heater exhaust and spreads polluted air throughout the house. Note: Because carbon monoxide accumulates in some detectors over time, as it does in the bloodstream, the source of CO may be appliances that were running before the alarm sounded.

A sticking thermostat can keep the furnace running continually, depleting the oxygen supply inside the house. This can lead to backdrafting. In multiple family dwellings where living spaces share walls and pipes, carbon monoxide from one unit may enter a neighboring space through floor boards, cracks or underneath doors. If a home has an attached garage, carbon monoxide produced by car exhaust can leak into the house. This is especially a problem for home mechanics who may run the car engine frequently for periods of time--even if the garage door is left open. Carbon Monoxide Vs Oxygen - Doctor answers on HealthTap Dr. Robert Kwok Dr. Kwok 4 doctors agreed: Yes: Carbon monoxide (co) stays tightly bound to hemoglobin, forming carboxyhemoglobin . Co comes off the hemoglobin gradually as the hours go by. Studies show carboxyhemoglobin's half-life to be about 4 hours (3-5 hr) in regular air, but about 1 hour (30-90 minutes) when breathing 100% oxygen for treatment of co poisoning. Increased oxygen makes the co come off the hemoglobin and leave the body sooner.

...Read more LPG USE AND CARBON MONOXIDE (C0) POISONING LPG USE AND CARBON MONOXIDE (C0) POISONING Definition LPG (liquid petroleum gas) is term used to define gases, which mostly contain 3 and 4 carbon (C3 and C4) hydrocarbons and can liquefy under low pressure. In its natural form, LPG is a colorless and scentless substance. It is denser than air and is stored in liquid form under pressure. Aromatisers are added for easy notice in case of leakage. As well as being used as domestic, commercial and industrial fuel, it also has area of use in automobiles under the name of autogas. LPG is also used propellant gas in spray cans we use. Chemical Composition It contains LPG propane (C3H8) and butane (C4H10) gases as well as ethyl mercaptan (ethane thiol) and similar sulfuric compounds in small amounts for odorization. With its form used in our country (as bottled gas and autogas), LPC contains 30% propane and 70% butane in terms of volume.

LPG, which is marketed to houses and the industry as bulk gas, contains propane at commercial purity. LPG Use Safety LPG is a highly combustible substance and quickly forms explosive air - hydrocarbon mixture when subjected to atmospheric conditions. LPG vapor is heavier than air. It can move away from its source with density difference and air movement, and accumulate in low code areas in open air, and lower floors in houses. Liquid leakages that may form in LPG systems can create combustible and explosive gas mixtures in large volumes (approximately, 1 unit volume LPG (liquid) forms 250 unit volumes of gas). LPG liquid forms cold burns when contacted with skin or eye. Inhaling LPG vapor at high concentration even for a short time can cause fainting and/or death. Inhaling of LPG vapor can cause irritation in nose and throat, headache and nausea, vomiting, dizziness and loss of consciousness. LPG vapor can cause fainting and choking in closed or poorly ventilated environments. First Aid In case of contact with eye: Eyes must be washed with a lot of cold water for at least 15 min.

During washing, eye must be opened with two fingers and eyeball and eyelids must be contacted with water. Following washing, you must reach the nearest health institution and seek for treatment. In case of contact with skin: If burn has formed on skin due to cold, dip the affected area into warm water and wait. Meanwhile, reach the nearest health institution for first aid. In case of contact through respiration: Gas at high concentrations can cause arrhythmia in the heart when inhaled. In such cases, the person, who has contacted with LPG, must be taken out for fresh air and sent to the nearest health institution. Precautions to be Taken In Case of LPG Leakages Since LPG has low flash point, leakages that may form can cause severe fire and/or explosions. If you have detected LPG leakage through tubes or tanks, immediately close the tube or tank valve and stop the leakage. Avoid actions that may start burning by sparking since a combustible gas mixture will form. Remove installations that may cause spark. Do not electric switch buttons. Ensure air circulation in the environment and immediately evacuate the personnel in the environment without causing panic or rush. Contact the fire department and the company concerned, if possible.

In case of leakage through tubes, you must act very carefully knowing that large amounts of gas will form and this gas will be heavier than air. Avoid all kinds of action that will start burning by sparking. Since the gas formed will accumulate near the surface, it can be transported to remote areas through air current and can cause fire and/or explosion through deflagration if it finds suitable environment there. Should there be suitable mechanism, try to disperse LPG in gaseous state with water spray. Since LPG vapor can accumulate in closed places, cover sinks, waste water installations and sewage connections. If the leakage has formed in closed areas such as room or kitchen, ensure air circulation by opening doors and windows and ventilate the environment for long time. Do not enter environments containing intense LPG vapor for purposes other than rescue or leakage stopping. In unavoidable circumstances, trained personnel must perform rescue operation by wearing protective clothing and breathing apparatus. Suggestions Regarding Bottled Gas Use · LPG, which is used in houses and work places, are put into use in our country inside bottles body of which is obtained through welding of two or three pieces to each other.

2 (camping type), 12 (house type) and 45 (industrial type) kg bottles are manufactured in accordance with TS 55 norms. · Tubes manufactured in accordance with TS 55 norms must have a minimum explosion pressure of 80 bars (internal pressure of a full bottle is 4-5 bars). Steel body of the bottle must not be contacted with high temperature for long time for explosion. · The incident, which is publicly known as tube explosion, is made up of meeting of the gas, which has leaked from bottle, with flame or spark and its explosion. · Bottled gas poisoning on the other hand, is used to explain two different incidents: 1) Becoming short of oxygen upon accumulation of the gas, which is heavier than air, in closed environment, 2) Becoming short of oxygen upon consumption of almost the entire oxygen during combustion in closed volumes and exposure to poisoning ending in death as a result of inhaling of combustion gases (e.g. carbon monoxide) arising due to insufficient oxygen. The best example for that is poisoning originating from geyser. · Pay attention to TS 55 mark when buying LPG bottle.

All bottles manufactured after 1981 have to have TSE brand. · It is very important where you place your LPG bottles. Bottles must not be exposed to direct sun light. Tubes must not be placed near heat producing devices such as radiator and stove. Do not place easily flammable materials near devices using LPG. Bottles must be kept vertical and in no way be tilted during use. Bottles must be kept at level lower than devices such as cookers and geysers. · If bottles are to be stored in closed area, you must open holes at the bottom that will provide ventilation. Bottles must not be stored in places such as basements, where air current cannot be provided. · If LPG is used in rooms or closed areas (such as LPG stove and cooker), constant clean air circulation must be ensured in the environment. · Hose connections used between LPG bottle and device must be provided with clamp. Hose must be jointless and patch-free and must not exceed 125 cm. Connection hose must be checked in regular intervals. Worn, cracked, softened or hardened hoses must be replaced immediately. Connection hose has its manufacture date written on it.

This date must be checked and the hose must be replaced if it has completed 3 years. · Regulators (hoods), which drop bottle pressure down to usage pressure, are important devices in terms of use safety. Gas flow stopping type hoods must be used when required in order to prevent high flow leakages that may occur in connection hose or LPG using devices. · Bottle replacement and leakage check during use must be performed with soap water. Do not use flaming objects such as match or lighter. · Geysers must definitely be connected to flue. The environment they are used in must be ventilated well and must have volume greater than 8 m3. Ventilation rules must be complied with. · Environments heated with LPG stove must be ventilated in regular intervals. Do not leave LPG stoves open while sleeping and do not use them in places smaller than 30 m3. · Do not place containers with large base on camping cylinders. Check in regular intervals and change where necessary the gasket, which provides impermeability and is found in the bottom of the armature attached on the tube.

CARBON MONOXIDE POISONING Carbon monoxide (CO) poisoning due to intentional or accidental exposure continues to be one of the most common poisoning-related death causes in developed/developing countries. CO poisoning increases and reaches its peak in winter particularly each year in our country. Value recommended for CO by the Environmental Protection Agency (EPA= and the World Health Organization (WHO) is determined as follows: 9 ppm for 8 hours, and maximum 25 to be taken in one hour. 'Air pollution', which we can define as mixing of various gases harmful to living metabolism into the air, is today a serious problem for entire humanity, particularly for large centers of population. Major part of air pollution arises from 'combustion reactions'. Carbon dioxide and water form when coal and petroleum products containing carbon and hydrogen molecules are burned. However, when 'full combustion' does not take place, gases such as carbon monoxide, which are very harmful and even deadly for human health, are produced. For example, car engines produce CO. CO has 52%, SO2, hydrocarbons and NO2 have 6% contribution to air pollution. Carbon monoxide is a gas that comes out upon combustion of carbon with insufficient oxygen.

If there is sufficient oxygen in combustion reactions, carbon dioxide forms instead of carbon monoxide. Carbon monoxide is a very toxic gas. An adult person dies in short time if he stays for half an hour in a closed room containing CO by 1%. Carbon monoxide is a colorless, scentless and tasteless gas, and comes out upon combustion of fossil fuels containing carbon. A stable gas, CO stays in the atmosphere for more than 2 months. Considering the fact that CO emission world-wide is 232 million tons in total, problem created by this amount for the world becomes more evident. More than 70% of the global CO emission comes from transportation sector. Moreover, it is calculated that this stable gas will increase each year by 0.03 ppm if carbon monoxide formation around the whole world stays in lower atmosphere. CO found in urban air has important impacts on human health. The most important of these impact is that carbon monoxide reduces the transportation capability of the hemoglobin cell in blood. Carbon monoxide is toxic/poisonous due to its particular interest in hemoglobin. It connects to hemoglobin 250 times more than oxygen and forms carboxyhemoglobin.

Low levels of carboxyhemoglobin can be detected in anyone. CO has insidious toxic effects. Cherry red color is observed on the skin due to red color of carboxyhemoglobin. Lips go red as if they are applied lipstick on it. Chest pain, headache, vomiting, tachycardia, irritability, confusion, respiratory failure and loss of consciousness can be regarded as important indicators. The person poisoned must be removed from the environment immediately, provided with fresh air and pure oxygen if any, and taken to the nearest health institution. CARBON MONOXIDE SOURCES Carbon monoxide is a combustion product/emission occurring as a result of incomplete combustion of hydrocarbons. CO concentration in the atmosphere is generally lower than 0.001%. Levels are higher in provinces than in rural areas. 1. AUTOMOBILE EXHAUST GAS: Carbon monoxide is both indoor and outdoor air pollutant. Vehicle exhausts are the most important CO sources in outdoors. When carbon monoxide is inhaled, it has harmful effects particularly on those working in crossroads and parking areas, which have dense traffic, and closed and poorly ventilated working environments such as car workshops.

Outer CO causing poisoning results from exhaust fumes of automobiles, poorly functioning heating systems and inhaling fumes. One cause of the headache experienced in people working in depots and warehouses arises from cranes operated with propane. Rate of death due CO arising from automobiles is higher in cold regions and reaches its peak in winter. Some deaths are related to poor ventilation of oil operated generators. It is known that although 'cleaner' fuels such as propane and methane burn almost completely, they can still cause carbon monoxide poisoning. 2. GAS LEAKAGE THROUGH STOVE: Hundreds of people in our country die due to poisoning from carbon monoxide gas arising from stoves or barbecues. Poisoning from carbon monoxide, which is a scentless and colorless gas, takes places without noticing at all. It has serious results from mild headache to come, stroke and death. Therefore you must not light open fire in places without ventilation and pay attention to pipe and flue cleaning when using stove. The most important precaution is not leaving the stove open at night while sleeping.

Indicators of carbon monoxide poisoning can be listed as follows: Drowsiness, dizziness, headache, nausea-vomiting, and blurriness in consciousness level, respiratory problem and visual impairment. A person with such indicators must be taken to open air immediately. He must be given kiss of life if necessary, and provided with oxygen if any. It is known that coal burning stoves, which are poorly heated and ignited from the bottom, and electric heaters increase risk of carbon monoxide poisoning. RECOMMENDATIONS FOR AVOIDING CO POISONING: Igniting stove from top, not closing air/fume lids of stove, flue cleaning, not putting coal on stove burning at night and not lighting stove during southwester. 3. POISONING FROM NATURAL GAS/BOTTLED GAS (LPG) GEYSER/COMBI BOILER: The reason for poisoning from geyser or gas is not providing fresh air entry into the bathroom while the gas is burnt or using the entire current oxygen in bathroom since geyser is not connected to flue. Poisonous CO gas starts forming if the oxygen in bathroom is reduced and continues to burn.

If there is no/poor flue connection, CO gas forming as a result of combustion spreads to the environment and causes poisoning. RECOMMENDATIONS FOR AVOIDING CO POISONING: Pilot system must be safe. Flue connected geysers must not be used. Geysers/combi boilers must be put in places with high air current. Sufficient air entry must be provided through ventilation culvert or door sil (minimum 1.5 cm gap). It is the best method not to place geyser in bathroom. Geysers must not be installed in places smaller than 8 m3. Geysers with flue gas detecting safety system must be preferred. 4. TOBACCO SMOKE: Tobacco smoke has some tranquilizers/stupefacient substances such as CO. These chemical substances suppress tension, anger and other strong emotions for a short time. Tobacco smoke is an important source of carbon monoxide. While the rate of carboxyhemoglobin often reaches 10% and can even exceed 15%, this amount is 1-3% in non-smokers. RECOMMENDATIONS FOR AVOIDING CO POISONING: Not smoking, avoiding smoking areas or not being smoke filled. 5.

FLUELESS HEATERS: Fuels such as kerosene, LPG (propane) and natural gas in particular, are used as fuel in fluless heaters. Gas Japanese stoves and heaters attached to camping cylinder are these types of stoves. Full combustion of these fuels in flueless heaters forms carbon dioxide and water vapor. Fresh air replacement rate must be 0.35/hour in places where flueless heater is used, and flueless heaters must in no way be used in impermeable rooms/houses. When the oxygen in the room drops, this must be detected with a detector and combustion must be stopped. Thermal efficiency of fluless heaters must be 99%. It must be checked whether flueless heaters burn with blue flame. Orange colored flame is an indicator of incomplete combustion and formation of carbon monoxide. Yellow flame means the flueless heater must by no means be used and must be repaired. RECOMMENDATIONS FOR AVOIDING CO POISONING: Flueless heaters must be used in places with dense human traffic and air current. They must not be used in bedrooms/bathrooms. Heater must be switched off before sleeping.

Heater depot must not be filled completely considering the fact that fuel will expand when heated. Flueless heaters must not be used in places 1350 m higher sea level since flame can go out due to low pressure. Flueless heaters, which have automatic gas cutting sensor and do not exceed 15 ppm/1 hour CO emission, must be used. × Carbon monoxide poisoning facts, information, pictures | Encyclopedia.com articles about Carbon monoxide poisoning Carbon monoxide poisoning Definition Carbon monoxide (CO) poisoning occurs when carbon monoxide gas is inhaled. CO is a colorless, odorless, highly poisonous gas that is produced by incomplete combustion. It is found in automobile exhaust fumes, faulty stoves and heating systems, fires, and cigarette smoke. Other sources include wood-burning stoves, kerosene heaters, improperly ventilated water heaters and gas stoves, and blocked or poorly maintained chimney flues. CO interferes with the ability of the blood to carry oxygen. The result is headache, nausea , convulsions, and finally death by asphyxiation. Description Carbon monoxide, sometimes called coal gas, has been known as a toxic substance since the third century B.C.

It was used for executions and suicides in early Rome . Anyone who is exposed to CO becomes sick, and the entire body is involved in CO poisoning. A developing fetus can also be poisoned if a pregnant woman breathes CO gas. Infants, people with heart or lung disease, or those with anemia may be more seriously affected. People such as underground parking garage attendants who are exposed to car exhausts in a confined area are more likely to be poisoned by CO. Firemen also run a higher risk of inhaling CO. Demographics Carbon monoxide is the leading cause of accidental poisoning in the United States . Experts estimate that 1,500 Americans die each year from accidental exposure to CO and another 2,300 from intentional exposure (suicide ). An additional 10,000 people seek medical attention after exposure to CO and recover. Causes and symptoms Normally when a person breathes fresh air into the lungs, the oxygen in the air binds with a molecule called hemoglobin (Hb) that is found in red blood cells. This process allows oxygen to be moved from the lungs to every part of the body. When the oxygen/hemoglobin complex reaches a muscle where it is needed, the oxygen is released.

Because the oxygen binding process is reversible, hemoglobin can be used over and over again to pick up oxygen and move it throughout the body. Inhaling carbon monoxide gas interferes with this oxygen transport system. In the lungs, CO competes with oxygen to bind with the hemoglobin molecule. Hemoglobin prefers CO to oxygen and accepts it more than 200 times more readily than it accepts oxygen. Not only does the hemoglobin prefer CO, it holds on to the CO much more tightly, forming a complex called carboxyhemoglobin (COHb). As a person breathes CO contaminated air, more and more oxygen transportation sites on the hemoglobin molecules become blocked by CO. Gradually, there are fewer and fewer sites available for oxygen. All cells need oxygen to live. When they do not get enough oxygen, cellular metabolism is disrupted and eventually cells begin to die. The symptoms of CO poisoning and the speed with which they appear depend on the concentration of CO in the air and the rate and efficiency with which a person breathes. Heavy smokers can start off with up to 9 percent of their hemoglobin already bound to CO, which they regularly inhale in cigarette smoke. This makes them much more susceptible to environmental CO.

The Occupational Safety and Health Administration (OSHA) has established a maximum permissible exposure level of 50 parts per million (ppm) over eight hours. With exposure to 200 ppm for two to three hours, a person begins to experience headache, fatigue, nausea, and dizziness . These symptoms correspond to 15 to 25 percent COHb in the blood. When the concentration of COHb reaches 50 percent or more, death results in a very short time. Emergency room physicians have the most experience diagnosing and treating CO poisoning. The symptoms of CO poisoning in order of increasing severity include the following: headache cardiac and respiratory failure death In some cases, the skin, mucous membranes, and nails of a person with CO poisoning are cherry red or bright pink. Because the color change does not always occur, it is an unreliable symptom to count on for diagnosis. Although most CO poisoning is acute, or sudden, it is possible to suffer from chronic CO poisoning. This condition exists when a person is exposed to low levels of the gas over a period of days to months.

Symptoms are often vague and include (in order of frequency) fatigue, headache, dizziness, sleep disturbances, cardiac symptoms, apathy, nausea, and memory disturbances. Little is known about chronic CO poisoning, and it is often misdiagnosed. When to call the doctor A healthcare professional should be consulted whenever more than passing exposure to carbon monoxide is suspected. While waiting for help to arrive, a potentially affected person should be moved outdoors. Diagnosis The main reason to suspect CO poisoning is evidence that fuel is being burned in a confined area, for example, a car running inside a closed garage, a charcoal grill burning indoors, or an unvented kerosene heater in a workshop. Under these circumstances, one or more persons suffering from the symptoms listed above strongly suggests CO poisoning. In the absence of some concrete reason to suspect CO poisoning, the disorder is often misdiagnosed as migraine headache, stroke , psychiatric illness, food poisoning , alcohol poisoning, or heart disease. Concrete confirmation of CO poisoning comes from a carboxyhemoglobin test. This blood test measures the amount of CO that is bound to hemoglobin in the body. Blood is drawn as soon after suspected exposure to CO as possible.

Other tests that are useful in determining the extent of CO poisoning include measurement of other arterial blood gases and pH; a complete blood count; measurement of other blood components such as sodium, potassium, bicarbonate, urea nitrogen, and lactic acid; an electrocardiogram (ECG); and a chest x ray. Treatment Immediate treatment for CO poisoning is to remove the victim from the source of carbon monoxide gas and into fresh air. If the victim is not breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be started. Depending on the severity of the poisoning, 100 percent oxygen may be given with a tight fitting mask as soon as it is available. Taken with other symptoms of CO poisoning, COHb levels of over 25 percent in healthy individuals, over 15 percent in people with a history of heart or lung disease, and over 10 percent in pregnant women usually indicate the need for hospitalization . In the hospital, fluids and electrolytes are given to correct imbalances that have arisen from the breakdown of cellular metabolism. In severe cases of CO poisoning, individuals are given hyperbaric oxygen therapy.

This treatment involves placing the person in a chamber in which the person breathes 100 percent oxygen at a pressure of more than one atmosphere (the normal pressure the atmosphere exerts at sea level). The increased pressure forces more oxygen into the blood. Hyperbaric facilities are specialized and are usually available only at larger hospitals. Prognosis The speed and degree of recovery from CO poisoning depends on the length of exposure to the gas and the concentration of carbon monoxide. The half-life of CO in normal room air is four to five hours, which means that in four to five hours half of the CO bound to hemoglobin will be replaced with oxygen. At normal atmospheric pressures, but breathing 100 percent oxygen, the half-life for the elimination of CO from the body is 50 to 70 minutes. In hyperbaric therapy at three atmospheres of pressure, the half-life is reduced to between 20 and 25 minutes. Although the symptoms of CO poisoning may subside in a few hours, some affected persons show memory problems, fatigue, confusion, and mood changes for two to four weeks after their exposure to the gas. Prevention Carbon monoxide poisoning is preventable.

Particular care should be paid to situations where fuel is burned in a confined area. Portable and permanently installed carbon monoxide detectors that sound a warning similar to smoke detectors are available for under $50. Specific actions that prevent CO poisoning include the following: Stop smoking . Smokers have less tolerance to environmental CO. Have heating systems and appliances installed by a qualified contractor to assure that they are properly vented and meet local building codes. Inspect and properly maintain heating systems, chimneys, and appliances. Do not use a gas oven or stove to heat the home. Do not burn charcoal indoors. Make sure there is good ventilation if using a kerosene heater indoors. Do not leave cars or trucks running inside the garage. Keep car windows rolled up when stuck in heavy traffic, especially if inside a tunnel. Parental concerns Parents should not allow children to play in areas heated by kerosene space heaters or to use charcoal grills of any kind indoors. KEY TERMS Carboxyhemoglobin —Hemoglobin that is bound to carbon monoxide instead of oxygen.

Hemoglobin —An iron-containing pigment of red blood cells composed of four amino acid chains (alpha, beta, gamma, delta) that delivers oxygen from the lungs to the cells of the body and carries carbon dioxide from the cells to the lungs. Hypothermia —A serious condition in which body temperature falls below 95°F (35 °C). It is usually caused by prolonged exposure to the cold. pH —A measurement of the acidity or alkalinity of a solution. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is a base; the higher the number, the stronger the base. Blood pH is slightly alkaline (basic) with a normal range of 7.36–7.44. Resources BOOKS Braunwald, Eugene, et al, eds. "Hypoxia and Cyanosis." In Harrison's Principles of Internal Medicine, 15th ed. New York : McGraw Hill, 2001, pp. 214–6.

Carbon Monoxide Poisoning: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego , CA: Icon Health Publications, 2004. Penney, David G. Carbon Monoxide Toxicity. Lakeland, FL: CRC Press, 2000. Robertson, William O. "Chronic Poisoning: Trace Metals and Others." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman, et al. Philadelphia: Saunders, 2003, pp. 91–9. PERIODICALS Harper A., and J. Croft-Baker. "Carbon monoxide poisoning: undetected by both patients and their doctors." Age and Ageing 33, no. 2 (2004): 105–9. Huffman, S. M. "Exposure to carbon monoxide from material handling equipment." Journal of Occupational and Environmental Hygiene 1, no. 5 (2004): D54–6. Piantadosi C. A. "Carbon monoxide poisoning." Undersea and Hyperbaric Medicine 31, no.

1 (2004): 167–77. Thomassen, O., G. Brattebo, M. Rostrup. "Carbon monoxide poisoning while using a small cooking stove in a tent." American Journal of Emergency Medicine 22, no. 3 (2004): 204–6. Vacchiano, G., and R. Torino. "Carbon-monoxide poisoning, behavioral changes and suicide: an unusual industrial accident." Journal of Clinical Forensic Medicine 8, no. 2 (2004): 86–92. ORGANIZATIONS American Academy of Clinical Toxicology. 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105–8820. Web site: < American Academy of Emergency Medicine. 611 East Wells Street, Milwaukee , WI 53202. Web site: < American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: < American Academy of Pediatrics.

141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: < American Association of Poison Control Centers. 3201 New Mexico Avenue NW, Washington, DC 20016. Web site: < American College of Emergency Physicians. PO Box 619911, Dallas , TX 75261–9911. Web site: < American College of Hyperbaric Medicine. PO Box 25914–130, Houston , Texas 77265. Web site: < American College of Occupational and Environmental Medicine. 55 West Seegers Road, Arlington Heights, IL 60005. Web site: < American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago , IL 60611. Web site: < International Congress on Hyperbaric Medicine. 1592 Union Street, San Francisco , CA 94123. Web site: < Undersea and Hyperbaric Medical Society. 10531 Metropolitan Ave, Kensington, MD 20895.

Web site: < WEB SITES "A Guide to Prevent Carbon Monoxide Poisoning." Industry Trade Group. Available online at < (accessed November 2, 2004). "Carbon Monoxide Poisoning." Centers for Disease Control and Prevention. Available online at < (accessed November 2, 2004). "Carbon Monoxide Poisoning." National Library of Medicine. Available online at < (accessed November 2, 2004). OTHER Carbon Monoxide Headquarters. Wayne State University School of Medicine. < (accessed November 2, 2004). L. Fleming Fallon Jr., MD, DrPH Cite this article Pick a style below, and copy the text for your bibliography. MLA Carbon Monoxide Poisoning Definition Carbon monoxide (CO) poisoning occurs when carbon monoxide gas is inhaled. CO is a colorless, odorless, highly poisonous gas that is produced by incomplete combustion. It is found in automobile exhaust fumes, faulty stoves and heating systems, fires, and cigarette smoke. Other sources include woodburning stoves, kerosene heaters, improperly ventilated water heaters and gas stoves, and blocked or poorly maintained chimney flues.

CO interferes with the ability of the blood to carry oxygen. The result is headache, nausea, convulsions, and finally death by asphyxiation. Description Carbon monoxide, sometimes called coal gas, has been known as a toxic substance since the third century B.C. It was used for executions and suicides in early Rome . Today it is the leading cause of accidental poisoning in the United States . According to the Journal of the American Medical Association, 2,000 Americans die each year from accidental exposure to CO, and another 2,300 from intentional exposure (suicide ). An additional 10,000 people seek medical attention after exposure to CO. The Consumer Products Safety Commission eported in 2004 that about 64% of unintentional CO poisoning deaths occur in the home. Anyone who is exposed to CO will become sick, and the entire body is involved in CO poisoning. A developing fetus can also be poisoned if a pregnant woman breathes CO gas. Infants, people with heart or lung disease, or those with anemia may be more seriously affected. People such as underground parking garage attendants who are exposed to car exhausts in a confined area are more likely to be poisoned by CO.

Firemen also run a higher risk of inhaling CO. Causes and symptoms Normally when a person breathes fresh air into the lungs, the oxygen in the air binds with a molecule called hemoglobin (Hb) that is found in red blood cells. This allows oxygen to be moved from the lungs to every part of the body. When the oxygen/hemoglobin complex reaches a muscle where it is needed, the oxygen is released. Because the oxygen binding process is reversible, hemoglobin can be used over and over again to pick up oxygen and move it throughout the body. Inhaling carbon monoxide gas interferes with this oxygen transport system. In the lungs, CO competes with oxygen to bind with the hemoglobin molecule. Hemoglobin prefers CO to oxygen and accepts it more than 200 times more readily than it accepts oxygen. Not only does the hemoglobin prefer CO, it holds on to the CO much more tightly, forming a complex called carboxyhemoglobin (COHb). As a person breathes CO contaminated air, more and more oxygen transportation sites on the hemoglobin molecules become blocked by CO. Gradually, there are fewer and fewer sites available for oxygen. All cells need oxygen to live.

When they don't get enough oxygen, cellular metabolism is disrupted and eventually cells begin to die. The symptoms of CO poisoning and the speed with which they appear depend on the concentration of CO in the air and the rate and efficiency with which a person breathes. Heavy smokers can start off with up to 9% of their hemoglobin already bound to CO, which they regularly inhale in cigarette smoke. This makes them much more susceptible to environmental CO. The Occupational Safety and Health Administration (OSHA) has established a maximum permissible exposure level of 50 parts per million (ppm) over eight hours. With exposure to 200 ppm for two to three hours, a person begins to experience headache, fatigue, nausea, and dizziness. These symptoms correspond to 15-25% COHb in the blood. When the concentration of COHb reaches 50% or more, death results in a very short time. Emergency room physicians have the most experience diagnosing and treating CO poisoning. The symptoms of CO poisoning in order of increasing severity include: headache cardiac and respiratory failure death In some cases, the skin, mucous membranes, and nails of a person with CO poisoning are cherry red or bright pink.

Because the color change doesn't always occur, it is an unreliable symptom to rely on for diagnosis. Although most CO poisoning is acute, or sudden, it is possible to suffer from chronic CO poisoning. This condition exists when a person is exposed to low levels of the gas over a period of days to months. Symptoms are often vague and include (in order of frequency) fatigue, headache, dizziness, sleep disturbances, cardiac symptoms, apathy, nausea, and memory disturbances. Little is known about chronic CO poisoning, and it is often misdiagnosed. Diagnosis The main reason to suspect CO poisoning is evidence that fuel is being burned in a confined area, for example a car running inside a closed garage, a charcoal grill burning indoors, or an unvented kerosene heater in a workshop. Under these circumstances, one or more persons suffering from the symptoms listed above strongly suggests CO poisoning. In the absence of some concrete reason to suspect CO poisoning, the disorder is often misdiagnosed as migraine headache, stroke, psychiatric illness, food poisoning, alcohol poisoning, or heart disease. Concrete confirmation of CO poisoning comes from a carboxyhemoglobin test. This blood test measures the amount of CO that is bound to hemoglobin in the body.

Blood is drawn as soon after suspected exposure to CO as possible. Other tests that are useful in determining the extent of CO poisoning include measurement of other arterial blood gases and pH; a complete blood count; measurement of other blood components such as sodium, potassium, bicarbonate, urea nitrogen, and lactic acid; an electrocardiogram (ECG); and a chest x ray. Treatment Immediate treatment for CO poisoning is to remove the victim from the source of carbon monoxide gas and get him or her into fresh air. If the victim is not breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be started. Depending on the severity of the poisoning, 100% oxygen may be given with a tight fitting mask as soon as it is available. Taken with other symptoms of CO poisoning, COHb levels of over 25% in healthy individuals, over 15% in patients with a history of heart or lung disease, and over 10% in pregnant women usually indicate the need for hospitalization. In the hospital, fluids and electrolytes are given to correct any imbalances that have arisen from the breakdown of cellular metabolism.

In severe cases of CO poisoning, patients are given hyperbaric oxygen therapy. This treatment involves placing the patient in a chamber breathing 100% oxygen at a pressure of more than one atmosphere (the normal pressure the atmosphere exerts at sea level). The increased pressure forces more oxygen into the blood. Hyperbaric facilities are specialized, and are usually available only at larger hospitals. Prognosis The speed and degree of recovery from CO poisoning depends on the length and duration of exposure to the gas. The half-life of CO in normal room air is four to five hours. This means that, in four to five hours, half of the CO bound to hemoglobin will be replaced with oxygen. At normal atmospheric pressures, but breathing 100% oxygen, the half-life for the elimination of CO from the body is 50-70 minutes. In hyperbaric therapy at three atmospheres of pressure, the half-life is reduced to 20-25 minutes. Although the symptoms of CO poisoning may subside in a few hours, some patients show memory problems, fatigue, confusion, and mood changes for two to four weeks after their exposure to the gas. Prevention Carbon monoxide poisoning is preventable.

Particular care should be paid to situations where fuel is burned in a confined area. Portable and permanently installed carbon monoxide detectors that sound a warning similar to smoke detectors are available for less than $50. Specific actions that will prevent CO poisoning include: stopping smoking. Smokers have less tolerance to environmental CO having heating systems and appliances installed by a qualified contractor to assure that they are properly vented and meet local building codes inspecting and properly maintaining heating systems, chimneys, and appliances not using a gas oven or stove to heat the home not burning charcoal indoors making sure there is good ventilation if using a kerosene heater indoors not leaving cars or trucks running inside the garage keeping car windows rolled up when stuck in heavy traffic, especially if inside a tunnel Resources "Silencing the Silent Killer." USA Today Magazine March 2004: 77. ORGANIZATIONS American Lung Association. 1740 Broadway , New York , NY 10019. (800) 586-4872. 〈〉 . OTHER "Carbon Monoxide Headquarters." Wayne State University School of Medicine. 〈〉.

KEY TERMS Carboxyhemoglobin (COHb)— Hemoglobin that is bound to carbon monoxide instead of oxygen. Hemoglobin (Hb)— A molecule that normally binds to oxygen in order to carry it to our cells, where it is required for life. Hypothermia— Development of a subnormal body temperature. pH— A measurement of the acidity or alkalinity of a fluid. A neutral fluid, neither acid nor alkali, has a pH of 7. Cite this article A Close Call The neighbors could set a clock by Dr. Smith’s morning routine. He turned off the porch light at 6:00 a.m., picked up the newspaper from the driveway at 6:15, and took the dog for a walk at 6:30. One winter morning, Dr. Smith’s next-door neighbor noticed that none of these things had happened. He knew the Smiths were home, but they did not answer the doorbell or the telephone. The neighbor called the police, who broke into the house and found four unconscious people. The gas heater had shut off during the night and had been giving off carbon monoxide gas for many hours.

The Smiths were rushed to the hospital and treated for carbon monoxide poisoning. Dr. Smith and his wife and children were lucky; they were found in time and recovered completely after several weeks. What is Carbon Monoxide (CO) Poisoning? Carbon monoxide (CO) is a chemical created when some fuels, such as coal and gas, are burned. CO is toxic because it reduces the amount of oxygen received by the body’s cells. Red blood cells contain a protein called hemoglobin that carries oxygen to the body’s cells. Because CO binds much more easily and tightly to hemoglobin than does oxygen, CO will replace oxygen in the bloodstream when inhaled. When that happens, the cells that need lots of oxygen, such as those of the heart, skeletal muscles, and central nervous system, cannot function properly. Acute CO poisoning Dr. Smith and his family suffered acute* CO poisoning, in which a large amount of CO was breathed at one time. This kind of poisoning can lead to death: it kills 25 to 40 percent of those exposed. Survivors may feel symptoms for days, months, or years. means sudden. Chronic CO poisoning CO poisoning also can be chronic* .

A small amount of CO inhaled continuously or frequently over a long period of time does not kill, but it does impair oxygen flow to the brain and may cause long-term nervous system problems, such as headaches, dizziness, weakness, sleepiness, nausea, and vomiting. Low-level chronic exposure to CO is especially serious for people with heart, lung, or circulatory problems, and for infants and older adults. Developing fetuses also can be affected by CO poisoning. Carbon Monoxide and the Environment CO is one of the most prevalent poisons in the environment. It can get into buildings, homes, and vehicles in many ways. Sources of CO include car exhaust, gas or oil furnaces, kerosene lamps, space heaters, improperly installed appliances, wood stoves, wood-burning fireplaces, and tobacco smoke. CO poisoning most often occurs during winter months, when people use heaters and fireplaces. How is CO Poisoning Treated? A person with acute CO poisoning requires extra oxygen as soon as possible. The individual may be given pure oxygen to breathe. A hyperbaric (hy-per-BARE-ik) oxygen chamber also may be used to treat CO poisoning. This is a large chamber that holds the patient, and sometimes the medical team.

The chamber is filled with 100 percent oxygen, and the pressure is increased to three atmospheres (three times the pressure of the air near the earths surface, or the pressure the body feels about 90 feet under water). Pressure and pure oxygen help the oxygen molecules displace the CO attached to hemoglobin. Diagnosis and treatment of chronic CO poisoning may be more difficult, because its symptoms are similar to flu and many other conditions. CO poisoning is usually preventable. Basic safety guidelines include: Never burning charcoal in a tent or camper to keep warm. Installing water heaters and gas appliances properly and checking them often to make sure they are operating correctly. Keeping chimneys and wood-burning fireplaces clean. Never letting a car idle inside a garage, especially if the garage is attached to the house. Installing commercial CO detectors (similar in design to smoke detectors) for the home. See also Resources The U.S. National Center for Environmental Health at the Centers for Disease Control and Prevention (CDC) posts a Checklist for the Prevention of Carbon Monoxide (CO) Poisoning at its website. The U.S.

National Institute of Neurological Disorders and Stroke posts a fact sheet at its website about anoxia and hypoxia from carbon monoxide inhalation and other causes. Cite this article

Question: Which gas released by car exhausts, stops the blood hemoglobin from working correctly?
Answer: Carbon Monoxide