Symptoms of Carbon Monoxide Exposure Can be Confused with Other Causes

How do people recognize the symptoms of carbon monoxide exposure?

A group of people enter into an environment where carbon monoxide levels are toxic, typically above 200 ppm. It might be a school, an office building or a hotel. After a half hour or so, someone gets sick, throws up or passes out. Other than concern for the ill person, very little else happens. Then the second person gets sick. Is the flu going around?  As know one knows the symptoms of carbon monoxide poisoning, it remains a puzzle. When the third person throws up, food poisoning will be suspected. Hopefully, someone will likely call 911 at that moment.

But since carbon monoxide is invisible and odorless, recognizing the emergency in the symptoms of carbon monoxide may still take a while. If there is a carbon monoxide detector present, it should have started to go off. Aware first responders will test the air for carbon monoxide immediately and call for evacuation if the levels are significant. But in many cases, the first responders don’t think carbon monoxide. We have seen cases where it took the first responders more than half an hour to make the connection, during which time the first responders worked in the environment without gas masks.

Acute Symptoms of Carbon Monoxide Exposure

The problem in recognizing that the illness is related to carbon monoxide exposure is that the symptoms of carbon monoxide poisoning are nonspecific. The symptoms often begin with headache, muscle pain, dizziness, or mild cognitive changes. When the carbon monoxide has reached levels in the blood above 20%, the acute symptoms of carbon monoxide exposure can include confusion and loss of consciousness. As the levels approach 50%, heart attack, organ failure and death can result. In a recent case, everyone thought the poisoned person was on dope, until the carbon monoxide symptoms were diagnosed.

Even when the exposures are low enough that none of these symptoms are connected with a toxic exposure, permanent brain damage my be the long-term consequence.  Repeated exposure to carbon monoxide where the poisoning is not identified until weeks or months after the beginning of the exposure is a separate topic which will be discussed in later pages, click here.

Permanent Residuals of Carbon Monoxide Exposure

The medical community general treats carbon monoxide exposure as a binary choice: either the poisoned patient dies or suffers profound disability, or they recover and are given a clean bill of health. Unfortunately, there is a very large middle ground, with more than 40% of those who have suffered significant exposures having permanent neuropsychiatric problems.

Symptoms of Carbon Monoxide Exposure Include:

  • Headache,
  • Heart Attack,
  • Arrhythmia,
  • Tachycardia,
  • Angina,
  • Hypertension,
  • Shortness of breath,
  • Dizziness,
  • Nausea,
  • Confusion and Disorientation,
  • Visual Changes,
  • Speech and Language Problems,
  • Motor Difficulties,
  • Impaired Memory,
  • Attention Problems,
  • Slowed Mental Processing,
  • Executive functioning disorders,
  • Decreased intellectual function,
  • Fatigue, and
  • Sleep Disturbance.

Brain Damage from Carbon Monoxide Poisoning

More significant than the itemization of a list like above, is these deficits combining together to create a neuropsychiatric syndrome more severe than any of the specific deficits alone. By neuropsychiatric deficits we mean thinking problems with thinking or cognition, changes in mood, changes in behavior and significant neurological problems that can change how the brain interfaces with the nervous system. Problems in this area can include visual problems, balance problems, EEG abnormalities, speech and language problems and motor difficulties. For more information click here.

Organ Damage from Carbon Monoxide Exposure

But as carbon monoxide attacks every cell in the human body, with the double edge pathology of anoxia and immunological damage (what refer to as the “poisoning effect”) permanent changes can occur almost anywhere.  Rarely is a connection made between carbon monoxide and these other areas of damage or dysfunction by diagnostic professionals. Thus, the full spectrum of the potential of damage from carbon monoxide exposure is under reported.

Traditional thinking is that only the areas that are the most oxygen dependent are likely to suffer permanent injury. Yet each year case studies describe more and more areas of long term sequelae from CO exposure. The areas of the body most prone to the hypoxic damage (lack of oxygen to the cells) are the cardiovascular system and the central nervous system. Even if more resilient to lack of oxygen, other areas are likely impacted by the poisoning effect of the carbon monoxide. Any organ can be damaged by the body’s defenses to the poison that is carbon monoxide in the blood stream. But as few diagnosticians are connecting the dots, the incidence of cellular and organ damage in other areas is unknown.

Headache an Early Warning of Carbon Monoxide

Often the first sign of carbon monoxide poisoning is headache. This explains how it can so often continue undiagnosed because dozens of other explanations why an individual has a headache may occur to the sufferer before anyone thinks of carbon monoxide exposure. Studies have shown that as high as 19% of all those reporting to emergency rooms are suffering from carbon monoxide. Heckerling 1987. Thus carbon monoxide has been nicknamed, “winter headache.”  For more on the relationship between carbon monoxide and headache, click here.

Carbon Monoxide Heart Attack

Carbon monoxide can cause any number of cardiovascular problems, including heart attack. The heart is an extremely oxygen demanding organ and when carbon monoxide takes the place of oxygen in the blood, the heart will run short of oxygen. This may create the same phenomenon as blocking a coronary artery, stopping the heart from beating. The most common cause of death from carbon monoxide is heart attack. Carbon monoxide is has a much greater tendency to bind with hemoglobin than oxygen, meaning that when the blood has a choice of carrying carbon monoxide than oxygen, it will always take the carbon monoxide. When the blood gets to the organ without the needed oxygen, the organ is starved for air, essentially. Such organs essentially become asphyxiated by blood that is too rich in oxygen. Death is a real possibility when the carboxyhemoglobin in blood reaches 50%, but cardiac problems can occur with carboxyhemoglobin (COHb) levels as low as 6%. For more on acute heart problems from carbon monoxide exposure, click here.