How Carbon Monoxide Poisoning Is Treated

Traditional and New Treatments for Carbon Monoxide Poisoning

Hemoglobin loves carbon monoxide and binds to it about 230 times stronger than it does to oxygen, which is a problem since carbon monoxide does not provide any benefit to the body. It doesn't take much carbon monoxide in the air you breathe to get carbon monoxide poisoning and it takes a lot of oxygen to get rid of it, which is what treatment revolves around.

Traditional Treatment

Carbon monoxide poisoning is not something you can treat at home. It takes, at a minimum, 100 percent oxygen concentration for several hours to rid the bloodstream of carbon monoxide. Carbon monoxide poisoning is one situation that is always appropriate for calling 911.

The basic treatment for carbon monoxide poisoning is to administer high-flow oxygen by non-rebreather mask—an oxygen mask with a plastic bag hanging off of it—for as long as it takes to replace the carbon monoxide attached to hemoglobin with oxygen. Half-life is a measurement of the time it takes to eliminate half of a substance in the body. The half-life of carbon monoxide without using oxygen is 320 minutes—more than five hours to reduce levels by half. At that rate, it would take about a day for the carbon monoxide to be removed.

Giving the patient 100 percent oxygen reduces the elimination half-life to 74 minutes, which means it will still take well over five hours for a moderately exposed patient to reach acceptable levels of carbon monoxide in the blood. Patients with carbon monoxide poisoning spend a lot of time sitting in the emergency department breathing straight oxygen.

Hyperbaric Oxygen Therapy

Another option is to administer oxygen under pressure in a hyperbaric chamber, which is essentially a tube in which the patient lies and breathes 100 percent oxygen at pressures 1.5 to 2 times higher than normal atmospheric pressure. In a hyperbaric chamber, oxygen therapy can reduce the elimination half-life of carbon monoxide to about 20 minutes.

Unfortunately, hyperbaric chambers are not always readily available, especially in rural areas. Even in areas that have access to hyperbaric oxygen therapy, it can take a couple of hours to arrange the treatment. Considering the patient will be receiving traditional oxygen administration during the waiting period, the benefit of a slightly faster treatment might already be lost. Plus, if multiple patients are affected by carbon monoxide exposure, only one at a time can be treated in the hyperbaric chamber.

While there is clear evidence that hyperbaric oxygen therapy clears carbon monoxide from the blood faster, there is little evidence that patients are better off because of it. One meta-analysis of randomized controlled trials found mixed results when looking at the neurological outcomes of carbon monoxide poisoned patients who received hyperbaric oxygen therapy. Hyperbaric therapy could possibly help the patient, but there's no reason to fret if it isn't readily available.

Other Treatments

Providing oxygen to reduce the levels of carbon monoxide in the bloodstream is just one part of carbon monoxide poisoning treatment. The damage done to the brain and heart because of a lack of oxygen in the blood during carbon monoxide poisoning requires treatment as well. Depending on the severity of the poisoning, patients could need support for brain and cardiac function. Some patients will need treatment for brain swelling, which could include medications and admission to the intensive care unit.

The heart is sensitive to a lack of oxygen and patients could experience cardiac irritability and arrhythmias, which could be treated in the hospital with medication or electrical therapy. High levels of free oxygen in the bloodstream—oxygen molecules that are not bound to hemoglobin, also known as free radicals—can also increase inflammation, which adds to the potential need for cardiac intervention.

Future Treatments

There are a few innovative treatments for carbon monoxide poisoning that are being developed. Many of these therapies could be many years away and all require significant additional study to determine safety and efficacy.

Light

Some wavelengths of light have shown, in animal studies, to accelerate the process of breaking molecular bonds between hemoglobin and carbon monoxide. If a process for getting the right color of light, one as close as possible to blood, is developed, it might provide a faster way to reduce carbon monoxide levels.

Oxygen Injections

Hyperoxygenated solutions injected directly into the bloodstream could provide a way to elevate oxygen levels beyond what is possible even with hyperbaric oxygen therapy. Early studies with mice look promising, but there's a long way to go before humans can try it.

Hydrogen Saline Solutions

Likewise, the use of hydrogen-rich saline solution as an antioxidant is available in some countries and could have some benefit for carbon monoxide poisoning. Damage from too much oxygen free-floating around the bloodstream, not binding to hemoglobin, is a potential drawback to all current treatment therapies. Using a strong antioxidant to control the potential damage could be nearly as important as reversing the carbon monoxide poisoning in the first place.

Alcohol Exposure

One study found that patients of intentional carbon monoxide poisoning who also drank alcohol had less overall brain damage when compared to patients with carbon monoxide poisoning alone. There is a chance that the presence of alcohol could make a difference in outcome for severe CO poisoning. Since the patients in this study were already drinking before the carbon monoxide poisoning, it could turn out that the only benefit happens if the alcohol comes first.

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