Need for Hyperbaric Oxygen in Reedsburg Carbon Monoxide Poisoning

The levels in the Reedsburg carbon monoxide poisoning were extremely high. We wrote about this story in our blog Sunday.

The levels of carbon monoxide in the Reedsburg, WI home were about 620 parts per million (ppm) in the second floor. The fire department found 240 ppm on the main floor of the home, and 150 ppm in the basement.

These levels were extremely high. Normal, fresh air should be 0 ppm. Nine ppm is the recommended maximum indoor carbon monoxide rate. 10-24 ppm pose potential health effects with long term exposure. At 200 ppm, dizziness, nausea, fatigue, and headache are expected after 2-3 hours of exposure. At 400 ppm, there will be headache and nausea after one to two hours of exposure. This can become deadly in three hours. At 800 ppm, headache, nausea, and dizziness are expected after 45 minutes. Collapse and unconsciousness are expected after one hour of exposure. This extremely high level can cause death within two to three hours. See the full chart here.

The Reedsburg carbon monoxide poisoning was situated right between 400 and 800 ppm. The home inhabitants were on the second floor where the levels were highest. If they had gone to sleep, they would not have woken up as death is expected in a couple of hours. The husband decided to take himself and his wife downstairs, open windows, and call their son. Luckily, the emergency personnel responded before the situation turned fatal.

Carbon monoxide levels are measured in the blood by taking carboxyhemoglobin levels. Hemoglobin is the protein in red blood cells that bind to oxygen. Since carbon monoxide binds to hemoglobin with 200 times the affinity of oxygen, the person becomes oxygen deprived. The carbon monoxide also releases toxins into the blood, such as glutamate. The carboxyhemoglobin levels are given in percentages.

With carboxyhemoglobin (COHb) level of 10-30 percent, symptoms such as headaches, dizziness and fatigue commonly occur. With COHb level of 30-50 percent, symptoms are nausea, severe headaches, dizziness, and increased pulse and respiration. With COHb more than 50 percent, you may see loss of consciousness, collapse, convulsions, coma, and finally death. Sometimes, carbon monoxide poisoning can be misdiagnosed as it could be mistaken for other common illnesses such as flu or food poisoning. See more information here.

The woman in the story was described as staring blankly into space. She was also having chest pains. Although her COHb levels were not released to the public, it is likely that she was between 30 and 50 percent. As she breathed fresh air, her COHb levels would have gone down as well. So, if she had her COHb levels measured at the hospital, she would have had lower levels than her peak COHb levels in the house.

In the most severe cases of carbon monoxide poisoning, as in this Reedsburg carbon monoxide poisoning, most doctors agree that hyperbaric oxygen should be provided as treatment. Hyperbaric oxygen is where 100 percent oxygen is delivered in a pressurized chamber. In a study by Dr. Lindell Weaver and colleagues, hyperbaric oxygen was shown to reduce cognitive sequelae. The half-life of carboxyhemoglobin in fresh air is about four hours. The total flushing of carboxyhemoglobin in the blood can take up to 12 to 24 hours. Hyperbaric oxygen can reduce carbon monoxide damage, brain damage, and can speed recovery.

Both the lack of oxygen and toxins released can cause brain damage. Most vulnerable are parts of the brain located deep in the brain, such as the hippocampus, which is in charge of memory. This is why we see problems with memory after CO poisoning. The corpus callosum may also be affected. Neurological and behavioral problems can occur in the two to 40 days following the actual poisoning. This is called delayed neurological sequelae or DNS.

Hopefully, hyperbaric oxygen treatment was given to the people poisoned in this Reedsburg carbon monoxide poisoning. It would give hope of a better outcome for the victims in this incident.