Carbon monoxide which is an odorless, colorless, non-irritating gas causes asphyxia by blocking the hemoglobin of the RBC from carrying oxygen to the tissues and from returning carbon dioxide to the lungs. The clinical symptoms of CO poisoning depend on the blood CO saturation level and in a healthy middle-aged individual a blood CO saturation greater than 50% is considered fatal. In forensic science, the investigation of the scene in cases of CO poisoning is imperative to determine the manner of death or the source of CO production, while postmortem diagnosis of CO poisoning is not difficult. The author reported four cases of CO poisoning in the unusual or atypical circumstances, which were not recognized in the scene.
Asphyxia ; Carbon Dioxide ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Forensic Sciences ; Lung ; Oxygen ; Poisoning

OBJECTIVE: To confirm whether formaldehyde disturb detecting carbon monoxide in blood. To give an evidence that can be used for detecting carboxyhemoglobin more accurately in carbon monoxide posioning appraises. METHODS: Blood samples came from carbon monoxide poisoning and the health were collected. Regular methods for detecting carboxyhemoglobin were used. Observing and comparing the detection results between which were spiked with methanal and no spiked one were performed. RESULTS: Methanal will affect the result of following experiments such as heating, adding NaOH, absorbed by PdCl2 and spectrophotometry. CONCLUSION The samples which contaminated by formaldehyde couldn't be used for detecting carboxyhemoglobin.
Carbon Monoxide/blood* ; Carbon Monoxide Poisoning/diagnosis* ; Carboxyhemoglobin/analysis* ; Forensic Medicine ; Formaldehyde/pharmacology* ; Humans ; Spectrophotometry/methods* ; Temperature

PURPOSE: Humans have been poisoned by carbon monoxide(CO) ever since they first discovered hydrocarbon fuels, incomplete combustion of which is the usual cause of the poisoning. The early symptoms of CO poisoning are usually variable, vague, and nonspecific, which can lead to thewrong diagnosis. METHODS: This study reviewed 42 cases of CO poisoning that occurred from January 1, 1995, to December 31, 2001. The study was conducted retrospectively to discover the patients' age distribution, sex ratio, the time of exposure, the site of exposure, and the cause of exposure. RESULTS: The ratio of males to females was 1:2.9. Age distribution was broad: 8 of below 18 years old, 9 between 19 and 39 years old, 9 between 40 and 59 years old, and 16 over 60 years old. In terms of seasonal difference, 28 cases happened during the heating season whereas 13 cases occurred in non-heating season. Twenty-three (23) cases happened in the early morning, 12 during the day time, 3 in the evening, and 4 during night. Of the exposures, 27 occurred in the home, 8 in the workplace, and 7 in hotels. Faulty heating systems caused 31 exposures, fires 2 exposures, stoves 4 exposures, and generators 5 exposures. Fifteen patients were repoisoned by CO, and of these, 9 patients had been misdiagnosed in the past exposures. CONCLUSION: The sources of CO are variable, so humans are poisoned often. It is common to see that the victim - sometimes even several members of the same family - had already visited a doctor with symptoms of CO toxicity before the severe exposures or death. The doctor strongly needs to pursue the possibility of victim poisoning when patients have recurrent or vague symptoms similar to those associated with CO exposure.
Adolescent ; Adult ; Age Distribution ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Female ; Fires ; Heating ; Hot Temperature ; Humans ; Male ; Middle Aged ; Poisoning ; Retrospective Studies ; Seasons ; Sex Ratio

Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by transient headache, altered mental functioning, seizures, and loss of vision associated with findings of predominantly posterior cerebral lesions on imaging studies. Magnetic resonance imaging typically shows bilateral hyperintensity on T2 weighted imaging and fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. The common etiologies of PRES include eclampsia, renal impairment, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension. The prognosis is usually benign when adequate treatment is initiated immediately. Otherwise, delay in diagnosis and treatment may lead to permanent neurological sequelae. We report on the case of a 24-year-old man who presented with the characteristics of PRES with acute carbon monoxide poisoning.
Autoimmune Diseases ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Hypertension ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Poisoning ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Prognosis ; Seizures ; Young Adult

Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by transient headache, altered mental functioning, seizures, and loss of vision associated with findings of predominantly posterior cerebral lesions on imaging studies. Magnetic resonance imaging typically shows bilateral hyperintensity on T2 weighted imaging and fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. The common etiologies of PRES include eclampsia, renal impairment, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension. The prognosis is usually benign when adequate treatment is initiated immediately. Otherwise, delay in diagnosis and treatment may lead to permanent neurological sequelae. We report on the case of a 24-year-old man who presented with the characteristics of PRES with acute carbon monoxide poisoning.
Autoimmune Diseases ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Hypertension ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Poisoning ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Prognosis ; Seizures ; Young Adult

Carbon monoxide (CO) poisoning is the most common cause of fatal poisoning in the United States and may be the most common worldwide cause of fatal poisoning. CO poisoning can affect the entire body and usually causes neurologic or cardiac injury. While not common, rhabdomyolysis, skeletal muscle necrosis, and renal failure can also occur. We report on a suicidal 22-year-old man who inhaled CO gas from a burning briquette. His case was complicated by compartment syndrome (CS). Finally, he had to undergo fasciotomy and removal of necrotic muscle. A CO poisoned patient who is unconscious cannot describe symptoms and moderate swelling or tenderness might be neglected. Though CS rarely appears in CO poisoning, delayed diagnosis may result in fatal consequences. Therefore, in the case of an unconscious patient, the entire body must be examined closely to identify early signs related to CS (tenderness, swelling, redness). If the diagnosis is uncertain after the clinical evaluation, the pressure within the compartment should be measured.
Burns ; Carbon Monoxide ; Carbon Monoxide Poisoning* ; Compartment Syndromes* ; Delayed Diagnosis ; Diagnosis ; Humans ; Muscle, Skeletal ; Necrosis ; Poisoning ; Renal Insufficiency ; Rhabdomyolysis ; United States ; Young Adult

Objective: To analyze the correlation of bispectral index (BIS) with the prognosis of patients with acute severe carbon monoxide poisoning (ASCMP) and its predictive value of adverse outcomes. Methods: In March 2021, 106 ASCMP patients who were treated in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to December 2020 were taken as research objects. All patients underwent 24-hour BIS monitoring after admission, and were divided into good prognosis group (n=75) and poor prognosis group (n=31) according to the prognosis of the patients' cranial nerve function after 60 d. The general conditions, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Glasgow Coma Scale (GCS) score at admission and 24-hour BIS mean were compared between the two groups. Pearson correlation analysis was used to analyze the correlations between the 24-hour BIS mean and GCS score at admission, APACHEⅡ score and coma time. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of 24-hour BIS mean, GCS score at admission, APACHEⅡ score and coma time on adverse outcome of ASCMP patients. Results: The coma time and APACHEⅡ score of the patients in the poor prognosis group were significantly higher than those in the good prognosis group, the GCS score at admission and 24-hour BIS mean were significantly lower than those in the good prognosis group (P<0.05) . Pearson correlation analysis showed that the 24-hour BIS mean was positively correlated with the GCS score at admission, and negatively correlated with the APACHEⅡ score, coma time (r=0.675, -0.700, -0.565, P<0.001) . The 24-hour BIS mean had the highest predictive value for adverse outcome of ASCMP patients, with a cut-off value of 74, the area under the curve was 0.883 (95%CI: 0.814-0.951, P<0.001) , and the sensitivity and specificity were 73.3% and 87.1%, respectively. Conclusion: The 24-hour BIS mean has a good correlation with the acute brain nerve injury, the severity of the disease and coma time of patients with ASCMP. And it has a high predictive value for the adverse outcome in patients with ASCMP.
APACHE ; Brain Injuries ; Carbon Monoxide Poisoning/diagnosis* ; Coma ; Humans ; Prognosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVE: To investigate factors affecting the determination of the percent carboxyhemoglobin saturation (HbCO%) of blood in an attempt to offer further data for results interpretation and sample storage requirement. METHODS: The HbCO% of blood samples stored in various conditions were detected by three spectrophotometries during the succeeding 30 days. RESULTS: The data detected by reductive double-wavelength spectrophotometry and double-wavelength spectrophotometry were more stable than mono-wavelength spectrophotometry. The HbCO% of blood was significantly related with the storage conditions which include temperature, time and the degree of exposure to air. CONCLUSION Determinations of HbCO% are reliable which performed by reductive double-wavelength spectrophotometry and double-wavelength spectrophotometry, combine with spectral scans. During 30 days, blood stored at 4 degrees C exposed to a limited volume of air does not influence the determination of HbCO%.
Carbon Monoxide Poisoning/diagnosis* ; Carboxyhemoglobin/analysis* ; Forensic Medicine ; Humans ; Spectrophotometry/methods* ; Temperature

Adult ; Carbon Monoxide Poisoning ; complications ; psychology ; Humans ; Male ; Middle Aged ; Nervous System Diseases ; chemically induced ; diagnosis ; physiopathology ; Suicide, Attempted ; psychology

Obtaining a complete and accurate history is one of the most crucial steps in the initial diagnosis and subsequent management of the poisoned patients. This information can then be integrated with physical evidence, clinical examination, laboratory and toxicological data in designing a therapeutic approach. Such information may include patient data, product information, and nature of exposure. The basic treatment for acute poisoning, whether of drug or chemical, is mainly symptomatic and supportive. The four cardinal principles of good management are ① identification of the causative drug or chemical as quickly as possible, ② evacuation of the poison from the stomach, except when contraindicated, ③ administration of an antidote if available, and ④ symptomatic and supportive therapy as indicated. Management in most cases of toxicity consists of supportive care, symptomatic treatment, and avoidance of exposure to the toxic material. In cases of life-threatening toxicity, maintenance of cardiopulmonary function and fluid and electrolyte balance are important. There are limited specific methods of treatment, or "antidotes". Use of oxygen counters the foxic effect and enhances the elimination of carbon monoxide. In cases acute cyanide of hydrogen sulfide poisoning, nitrites may be used to generate formation of cyanmethemoglobin or sulfmethemoglobin. Hydroxocobalamin can also be used as an antidote for cyanide. Atropine and pralidoxime can be life-saying in reversing the acute cholinesterase-inhibiting effects of organophosphate pesticides. Chelating agents may reverse acute toxicity caused by some metals.
Atropine ; Carbon Monoxide ; Chelating Agents ; Diagnosis ; Humans ; Hydrogen Sulfide ; Hydroxocobalamin ; Metals ; Nitrites ; Oxygen ; Pesticides ; Poisoning* ; Stomach ; Water-Electrolyte Balance