DRHOOK- It's a gas: Carbon monoxide a sneaky lethal killer

the handsome doctor John Hong of Charlottesville

Suffocating personalities. I'm sure you know some people who choke the life out of you. They stop by your house without notice, and then expect you to feed them. Phone calls after 10pm and voice mails: "Hi, why haven't you returned any of my 15 calls today?" 

You're always at fault, and they're perfect, especially when they walk on water.

 What a gas, huh? 

 Carbon monoxide, which made headlines earlier this year in a potentially lethal downtown incident, is kind of a suffocating gas. It binds to hemoglobin 240 times stronger than oxygen does, which results in poor oxygen delivery to the body. Carbon monoxide is made from burning hydrocarbons. Therefore, smoke inhalation is a main cause of carbon monoxide poisoning. Motor vehicles release carbon monoxide, so poorly ventilated parking garages and warehouses can accumulate toxic amounts of this gas. 

But there are also reported cases of motorboats in the open air that created cases of carbon monoxide poisoning. (That would totally change the opening of Gilligan's Island.) 

 Underground electrical cable fires can create enough carbon monoxide to seep into adjacent homes, which is one good reason to have a carbon monoxide detector at home. Improper ventilation with kerosene heaters, camping stoves, charcoal grills, and gasoline-powered electric generators can turn your camping trip into Friday The 13th. And these types of heaters also might explain why carbon monoxide poisoning occurs more often in the winter. 

 Dichloromethane, a component of paint remover and an industrial solvent, when inhaled or drunk, is metabolized in the liver to carbon monoxide. Smoking tobacco also introduces carbon monoxide, which is one reason many smokers have higher hemoglobin levels than nonsmokers. 

 Carbon monoxide is color-free, odorless, tasteless, and nonirritating. Sounds like a green organic product, huh? Well, it is natural– naturally lethal. It's one of the leading causes of poisoning deaths in USA: about 6,000 a year. There are 40,000 ER visits a year due to this scentless toxic gas.

 Headache is the main symptom, as well as nausea, vomiting, feeling under the weather, and dizziness. Most folks think they have come down with a virus. The lips and skin can become cherry red like a bad makeover job. Mental status changes can range from confusion to coma. Seizures can occur as well. 

Interestingly, neurological disorders often appear three days to eight months later, such as personality changes and movement disorders, so although most people are discharged from the ER after carbon monoxide poisoning, neurological problems can plague the person for a year or longer.

 In some bad cases of carbon monoxide poisoning, heart arrhythmias to heart attacks can occur and be lethal. In a sense, a person can drown if their lungs fill up with fluid. And the carbon monoxide can cause a deadly metabolic disarray.

 Treatment is mostly oxygen. In room air, it takes about five hours for the carbon monoxide to clear from the hemoglobin. With a mask and oxygen, it's only 90 minutes, and with hyperbaric oxygen therapy, it takes about 30 minutes. In Korea, however, where carbon monoxide has been pretty common, natives sniff vinegar for some reason— perhaps thinking it increases the ability of hemoglobin to carry oxygen. (Ew, I hate the smell of vinegar! I'd rather smell bad shoes.)

 Gas is such a sneaky toxin when it's scentless, because you don't know it's there. That's why natural gas is scented by the gas company. 

And although some people don't think their own gas stinks, it usually does– especially those with suffocating personalities. If you think you have carbon monoxide poisoning, call 911. Also an emergency medical toxicologist at the US Poison Control Network is standing by at 800-222-1222.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.