Carbon Monoxide Toxicity and its Management: A Review


  • Shahnawaz Ahmed Institute for Industrial Research and Toxicology, Ghaziabad, Uttar, Pradesh, India.
  • Susheel Kumar Institute for Industrial Research and Toxicology, Ghaziabad, Uttar, Pradesh, India.


Carbon monoxide (CO) is emitted by incomplete ignition of carbonaceous substance. It is a tasteless, odorless and colorless gas, and victims are typically turned into comatose before they realize they are being poisoned. Clinical appearance in patients with CO poisoning starts from headache and dizziness to coma and death. The results of CO poisoning on humans are not always same, and healthcare professionals are just beginning to understand these effects better. CO is the most abundant toxin in the lower environment. Hyperbaric oxygen therapy can notablylessen the morbidity of CO poisoning, but a portion of survivors still suffer noteworthy long-term neurologic and affective squeals.

How to cite this article: Ahmed S, Kumar S. Carbon Monoxide Toxicity and its Management: A Review. Int J Adv Res Med Chem 2020; 2(1): 11-19.


Rose JJ, Wang L, Xu Q et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med. 2017; 195(5): 596-606.

Anderson AR. Centers for Disease Control and Prevention (CDC). Top five chemicals resulting in injuries from acute chemical incidents-Hazardous Substances Emergency Events Surveillance, nine states, 19992008. MMWR Suppl. 2015; 64(2): 39-46.

Hampson NB, Piantadosi CA, Thom SR et al.Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med. 2012; 186(11): 1095-101.

Hampson NB, Dunn SL. Carbon Monoxide Poisoning from Portable Electrical Generators. J Emerg Med. 2015; 49(2): 125-9.

Workplace Safety and Health Topic: Carbon Monoxide (CO) Dangers in Boating. Centers for Disease Control and Prevention. Available at

niosh/topics/coboating/. July 1, 2018; Accessed: September 18, 2018.

Hawkes AP, McCammon JB, Hoffman RE. Indoor use of concrete saws and other gas-powered equipment. Analysis of reported carbon monoxide poisoning cases in Colorado. J Occup Environ Med 1998; 40(1): 49-54.

Nager EC, O’Connor RE. Carbon monoxide poisoning from spray paint inhalation. Acad Emerg Med 1998; 5(1): 84-6.

Beppu T. The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. AJNR Am J Neuroradiol 2014; 35(4): 625-31.

Suner S, Jay G. Carbon monoxide has direct toxicity on the myocardium distinct from effects of hypoxia in an ex vivo rat heart model. Acad Emerg Med 2008; 15(1): 59-65.

Carbon monoxide exposures--United States, 20002009. MMWR Morb Mortal Wkly Rep. 2011; 60(30): 1014-7.

Unintentional non-fire-related carbon monoxide exposures--United States, 2001-2003. MMWR Morb Mortal Wkly Rep. 2005; 54(2): 36-9.

Sircar K, Clower J, Shin MK et al. Carbon monoxide poisoning deaths in the United States, 1999 to 2012. Am J Emerg Med. 2015; 33(9): 1140-5.

Gummin DD, Mowry JB, Spyker DA et al. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017; 55(10): 1072-1252.

Routley VH, Ozanne-Smith J. The impact of catalytic converters on motor vehicle exhaust gas suicides. Med J Aust 1998; 168(2): 65-7.

Quick Stats: Average Annual Number of Deaths and Death Rates from Unintentional, Non–Fire-Related Carbon Monoxide Poisoning,*† by Sex and Age Group — United States, 1999–2010. MMWR Morb Mortal Wkly Rep. Available at mmwrhtml/mm6303a6.htm?s_cid=mm6303a6_e. Accessed: 2018.

Wrenn K, Conners GP. Carbon monoxide poisoning during ice storms: a tale of two cities. J Emerg Med. 1997; 15(4): 465-7.

Hurricane Florence-Clinical Guidance For Carbon Monoxide (CO) Poisoning. Centers for Disease Control and Prevention. Available at han/han00415.asp. 2018; Accessed: September 18, 2018.

Carbon monoxide poisonings after two major hurricanes-Alabama and Texas, August-October 2005. MMWR Morb Mortal Wkly Rep. 2006; 55(9): 236-9.

Centers for Disease Control and Prevention (CDC). Notes from the field: carbon monoxide exposures reported to poison centers and related to hurricane Sandy - Northeastern United States, 2012. MMWR Morb Mortal Wkly Rep. 2012; 61 (44): 905.

Falise AM, Griffin I, Fernandez D, Rodriguez X, Moore E, Barrera A, et al. Carbon Monoxide Poisoning in Miami-Dade County Following Hurricane Irma in 2017. Disaster Med Public Health Prep. 2018; 1-3.

Cook M, Simon PA, Hoffman RE. Unintentional carbon monoxide poisoning in Colorado, 1986 through 1991. Am J Public Health. 1995; 85(7): 988-90.

Cone DC, MacMillan D, Parwani V et al. Threats to life in residential structure fires. Prehosp Emerg Care 2008; 12(3): 297-301.

Hampson NB. Noninvasive pulse CO-oximetry expedites evaluation and management of patients with carbon monoxide poisoning. Am J Emerg Med 2012; 23.

[Guideline] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning:., Wolf SJ, Maloney GE, Shih RD, Shy BD, Brown MD. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning. Ann Emerg Med. 2017; 69(1): 98-107.e6.

Perrone J, Hoffman RS. Falsely elevated carboxyhemoglobin levels secondary to fetal hemoglobin. Acad Emerg Med. 1996; 3(3): 287-9.

Cha YS, Kim H, Hwang SO et al. Incidence and patterns of cardiomyopathy in carbon monoxide-poisoned patients with myocardial injury. Clin Toxicol (Phila). 2016; 11; 1-7.

Henry CR, Satran D, Lindgren B et al. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006; 295(4): 398402.

Damlapinar R, Arikan FI, Sahin S et al. Lactate Level Is More Significant Than Carboxihemoglobin Level in Determining Prognosis of Carbon Monoxide Intoxication of Childhood. Pediatr Emerg Care 2015; 37 (1):1-7.

Jung JW, Lee JH. Serum lactate as a predictor of neurologic outcome in emergency department patients with acute carbon monoxide poisoning. Am J Emerg Med 2018; 24.

Jones JS, Lagasse J, Zimmerman G. Computed tomographic findings after acute carbon monoxide poisoning. Am J Emerg Med. 1994 Jul. 12(4):448-51. [Medline].

So GM, Kosofsky BE, Southern JF. Acute hydrocephalus following carbon monoxide poisoning. Pediatr Neurol 1997; 17(3): 270-3.

Inagaki T, Ishino H, Seno H, Umegae N, Aoyama T. A long-term follow-up study of serial magnetic resonance images in patients with delayed encephalopathy after acute carbon monoxide poisoning. Psychiatry Clin Neurosci. 1997; 51(6): 421-3.

Bozeman WP, Myers RA, Barish RA. Confirmation of the pulse oximetry gap in carbon monoxide poisoning. Ann Emerg Med. 1997; 30(5): 608-11.

Roth D, Mayer J, Schreiber W et al. Acute carbon monoxide poisoning treatment by non-invasive CPAP-ventilation, and by reservoir face mask: Two simultaneous cases. Am J Emerg Med. 2018; 36(9): 1718.e5-1718.e6.

Chin W, Jacoby L, Simon O et al. Hyperbaric programs in the United States: Locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: survey results. Undersea Hyperb Med. 2016; 43(1): 29-43.

Buckley NA, Isbister GK, Stokes B et al. Hyperbaric oxygen for carbon monoxide poisoning: a systematic review and critical analysis of the evidence. Toxicol Rev. 2005; 24(2): 75-92.

Buckley NA, Juurlink DN, Isbister G et al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011; 4:CD002041.

Rose JJ, Nouraie M, Gauthier MC et al. Clinical Outcomes and Mortality Impact of Hyperbaric Oxygen Therapy in Patients With Carbon Monoxide Poisoning. Crit Care Med 2018; 46(7): e649-e655.

Huang CC, Ho CH, Chen YC et al. Hyperbaric Oxygen Therapy Is Associated With Lower Short and Long Term Mortality in Patients With Carbon Monoxide Poisoning. Chest. 2017; 152(5): 943-953.

Turner M, Esaw M, Clark RJ. Carbon monoxide poisoning treated with hyperbaric oxygen: metabolic acidosis as a predictor of treatment requirements. J Accid Emerg Med 1999; 16(2): 96-8.

Sloan EP, Murphy DG, Hart R et al. Complications and protocol considerations in carbon monoxide-poisoned patients who require hyperbaric oxygen therapy: report from a ten-year experience. Ann Emerg Med 1989; 18 (6): 629-34.

Lai CY, Huang YW, Tseng CH et al. Patients With Carbon Monoxide Poisoning and Subsequent Dementia: A Population-Based Cohort Study. Medicine (Baltimore) 2016; 95 (1):e2418.

Lai CY, Chou MC, Lin CL et al. Increased risk of Parkinson disease in patients with carbon monoxide intoxication: a population-based cohort study. Medicine (Baltimore) 2015; 94(19):e869.

Krenzelok EP, Roth R, Full R. Carbon monoxide ... the silent killer with an audible solution. Am J Emerg Med 1996; 14(5): 484-6.

Hampson NB, Piantadosi CA, Thom SR et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J RespirCrit Care Med 2012; 186(11): 1095-101.

Lane TR, Williamson WJ, Brostoff JM. Carbon monoxide poisoning in a patient with carbon dioxide retention: a therapeutic challenge. Cases J 2008; 1(1): 102.

Bourtros AR, Hoyt JL. Management of carbon monoxide poisoning in the absence of hyperbaric oxygenation chamber. Crit Care Med 1976; 4(3): 144-7.

Dogan N, Savrun A, Levent S et al. Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning?. Hum Exp Toxicol 2014.

Leem JH, Kaplan BM, Shim YK et al. Exposures to air pollutants during pregnancy and preterm delivery. Environ Health Perspect 2006; 114(6): 905-10.

Suner S, Partridge R, Sucov A et al. Non-invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. J Emerg Med. 2008; 34(4): 441-50.

Hoesen KV. Hyperbaric oxygen therapy. Rosen P et al, eds. Emergency Medicine: Concepts and Clinical Practice. 2nd ed. St. Louis, Mo: Mosby-Year Book; 1998. 1032-42.