Current treatment options for carbon monoxide-induced neurological dysfunction

Carbon monoxide is an established dangerous toxicant with a complex mechanism of cellular toxicity. It is known to cause various neurological symptoms which can manifest both in acute as well as chronic forms. Delayed neurological deficits are often less recognizable. Radiological findings are also less specific. Hyperbaric oxygen therapy has been the mainstay of treatment over the years but is associated with its own list of complications and controversies. Current management for this important condition is discussed here. 

___

  • [1] Kao L, Nanagas K. Toxicity associated with carbon monoxide. Clin Lab Med 2006;26:99-125.
  • [2] Tomaszewski C. Carbon monoxide. In: Goldfrank LR, Flomenbaum NE, Lewin NA, et al, editors. Goldfrank’s toxicologic emergencies. 7th edition. New York: McGraw-Hill; 2002. p. 1478-97.
  • [3] Cobb N, Etzel RA. Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988. JAMA 1991;266:659-63.
  • [4] Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med 1998;339:1603-8.
  • [5] Abelsohn A, Sanborn MD, Jessiman BJ, Weir E. Identifying and managing adverse environmental health effects. 6. Carbon monoxide poisoning. CMAJ 2002;166:1685-90.
  • [6] Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning--a public health perspective. Toxicology 2000;145:1-14.
  • [7] Stewart RD. The effect of carbon monoxide on humans. Annu Rev Pharmacol 1975;15:409-22.
  • [8] Mehta SR, Das S, Singh SK. Carbon monoxide poisoning. MJAFI 2007;63:362-5.
  • [9] Ely EW. Moorehead B, Haponik EF. Warehouse workers’ headache: emergency evaluation and management of 30 patients with carbon monoxide poisoning. Am J Med 1995;98:145-55.
  • [10] Longo LD, Hill EP. Carbon monoxide uptake and elimination in fetal and maternal sheep. Am J Phsiol 1977;232:324-30.
  • [11] Gilbert GJ, Glaser GH. Neurologic manifestations of chronic carbon monoxide poisoning. N Eng J Med 1959;264:1217-220.
  • [12] Smith JS, Brandon S. Morbidity from acute carbon monoxide poisoning at three-year follow-up. Br Med J 1973;1:318-21.
  • [13] Messier LD, Myers RA. A neuropsychological screening battery for emergency assessment of carbon-monoxide-poisoned patients. J Clin Psychol 1991;47:675-84.
  • [14] Silver DA, Cross M, Fox B, Paxton RM. Computed tomography of the brain in acute carbon monoxide poisoning. Clin Radiol 1996;51:480-3.
  • [15] Kinoshita T, Sugihara S, Matsusue E, Fujii S, Ametani M, Ogawa T. Pallidoreticular damage in acute carbon monoxide poisoning: diffusion-weighted MR imaging findings. Am J Neuroradiol 2005;26:1845-8.
  • [16] Oh S, Choi SC. Acute carbon monoxide poisoning and delayed neurological sequelae: a potential neuroprotection bundle therapy. Neural Regen Res 2015;10:36-8.
  • [17] Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 2002; 347:1057-67.
  • [18] Juurlink DN, Buckley NA, Stanbrook MB, Isbister GK, Bennett M, McGuigan MA. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev 2005;(1):CD002041.
  • [19] Hampson NB, Mathieu D, Piantadosi CA, Thom SR, Weaver LK. Carbon monoxide poisoning: interpretation of randomized clinical trials and unresolved treatment issues. Undersea Hyperb Med 2001;28:157-64.
  • [20] Pang L, Bian M, Zang XX, Wu Y, Xu DH, Dong N, et al. Neuroprotective effects of erythropoietin in patients with carbon monoxide poisoning. J Biochem Mol Toxicol 2013;27:266-71.
  • [21] Azarov I, Wang L, Rose JJ, Xu Q, Huang XN, Belanger A, et al. Five-coordinate H64Q neuroglobin as a ligand-trap antidote for carbon monoxide poisoning. Sci Transl Med 2016;8:368ra173.
  • [22] Rydzewski J, Nowak W. Photoinduced transport in an H64Q neuroglobin antidote for carbon monoxide poisoning. J Chem Phys 2018;148:115101