Causes and Risk Factors of Carbon Monoxide Poisoning

Carbon monoxide poisoning is caused by inhalation of carbon monoxide (CO) gas. The gas is odorless and colorless. It binds to hemoglobin, the iron-based protein in red blood cells that makes them red and carries oxygen. It only takes a small amount of carbon monoxide in the air to bump oxygen molecules off of the hemoglobin, and the amount usually comes accidentally from various sources of combustion.

Common Accidental Causes

Carbon monoxide is a product of combustion. Any combustion will give it off. Car exhaust is a well-known source, but so are wood fires and gas appliances—stoves, fireplaces, and water heaters, for example.

Some instances of accidental carbon monoxide poisoning come from inappropriate use of devices such as stoves, barbecues, or generators inside homes or buildings. However, most incidents are from equipment failure usually related to the ventilation of things like furnaces or motor vehicles.

Disaster Response/Recovery

Carbon monoxide is produced by many survival items used during natural disasters. It is common during the recovery period following a disaster to see increased emergency department visits for carbon monoxide poisoning.

Using survival items like generators or camp stoves is often done in less than ideal conditions. Often, the makeshift nature of the situation can make it easy to forget basic ventilation needs.

Intentional Poisoning

About 4% of all suicides in the United States use some form of gas. Of those, 73% involved carbon monoxide poisoning.

The source of CO gas in the vast majority of all intentional carbon monoxide poisoning comes from motor vehicles or other combustion engines. Burning coal accounts for approximately 13%, a distant second.

Acute vs. Chronic Exposure

Carbon monoxide poisoning occurs from a buildup of CO gas in the bloodstream, measured by the amount of hemoglobin that is saturated with carbon monoxide molecules. The binding of hemoglobin and carbon monoxide creates what is known as carboxyhemoglobin. High levels of carboxyhemoglobin lead to tissue damage in the brain and heart from a combination of blocking oxygen and of causing inflammation.

Building up carboxyhemoglobin can happen slowly (chronic exposure) or quickly (acute exposure). Chronic exposure is often caused by a faulty or poorly ventilated appliance in the home that leads to the presence of low concentrations of carbon monoxide in the air. Think of this as a slowly leaking roof that eventually fills up a bucket placed below it.

Acute exposure typically comes from an accidental change in environment that leads to a high concentration of carbon monoxide in the air. In that case, the levels of carboxyhemoglobin rise quickly and symptoms are more pronounced. Acute exposure is more easily recognized and more often reported.

Prevention

Proper use and maintenance of devices that release carbon monoxide is the best way to avoid accidental carbon monoxide poisoning. Additionally, recognizing the signs and symptoms of carbon monoxide poisoning when there is the possibility could save a life.

Since the symptoms of carbon monoxide poisoning are so vague, it is important to consider the possibility anytime there are gas appliances in the home or the possibility of CO coming in from a garage or nearby combustion engine. There are numerous examples of patients with carbon monoxide poisoning that occurred because of a car idling next to an open window.