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Carbon monoxide (carbon monoxide) poisoning in a child\
Last reviewed: 07.07.2025
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Carbon monoxide (CO) has a much stronger affinity for hemoglobin than oxygen and forms a strong bond with hemoglobin - carboxyhemoglobin, which prevents normal oxygen transfer to tissues. The toxic effect of CO is not limited to the development of tissue hypoxia and a shift in the oxyhemoglobin dissociation curve. Carbon monoxide binds cytochromes, leading to respiratory depression at the mitochondrial level and lactic acidosis. Demyelination of the white matter of the brain, edema, necrosis, and petechial hemorrhages develop. Myocardial depression with the development of arterial hypotension is characteristic.
The clinical picture of acute carbon monoxide poisoning is characterized by increasing hypoxia of the central nervous system (decreased attention, impaired perception of light, headaches, dizziness, tinnitus). Upon examination, the skin is pale or dark cherry (blue-purple) in color, skin necrosis with the formation of blisters may develop. Nausea, vomiting, and muscle weakness occur. Breathing is shallow, intermittent, convulsions, loss of consciousness, and development of shock are possible. The cause of death in carbon monoxide poisoning is pulmonary and cerebral edema.
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Emergency medical care for carbon monoxide poisoning
It is necessary to immediately remove the victim from the contaminated area.
Conscious patients are periodically given 10% ammonia solution (ammonia) to inhale to stimulate the respiratory center. It is necessary to inspect the upper respiratory tract; if respiratory depression occurs, assisted breathing and oxygenation with pure oxygen (100%) are required. If pulmonary edema develops, tracheal intubation, mechanical ventilation under positive pressure of 4-6 cm H2O, and dehydration (furosemide 1-2 mg/kg) are required. The victim is warmed, and cold is applied to the head area if possible.
The level of carboxyhemoglobin and the gas composition of the blood are determined, an ECG and chest X-ray are performed. In case of cerebral edema, it is necessary to use osmotic diuretics - mannitol 1-1.5 g/kg - and hyperbaric oxygenation under pressure up to three atmospheres.
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