Noninvasive measurement of carboxyhemoglobin levels for adjustment of diffusion capacity measured during pulmonary function testing.

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Mahoney, Anne M; Stimpson, Claudia L; Scott, Karen L; Hampson, Neil B

2007-12-01

The diffusing capacity of the lungs for carbon monoxide (D(LCO)) is commonly measured during pulmonary function testing (PFT). Although adjustment of the measured D(LCO) for an elevated baseline carboxyhemoglobin level is recommended, carboxyhemoglobin is not routinely measured, which may reduce the accuracy of D(LCO) measurements. We sought to assess the utility of routine carboxyhemoglobin measurement and subsequent D(LCO) correction in patients referred for PFT. We retrospectively reviewed 100 consecutive PFT results, including D(LCO) assessment. We used a pulse CO-oximeter (recently approved by the Food and Drug Administration) to noninvasively measure baseline carboxyhemoglobin (S(pCO)). We used simple descriptive statistics to compare the S(pCO) values. In subjects with elevated S(pCO) (> 2%) we adjusted the percent-of-predicted D(LCO). Interpretation of D(LCO) was categorized according to the American Thoracic Society classification scheme for respiratory impairment. The self-reported smokers had higher average S(pCO) than did self-reported nonsmokers (1.6% vs 3.5%, p carboxyhemoglobin is easy to perform during PFT. When precise measurement of D(LCO) is important, noninvasive measurement of carboxyhemoglobin may be of value. If routine S(pCO) measurement is considered, the highest yield is among current smokers.

[Carboxyhemoglobin concentration in carbon monoxide poisoning. Critical appraisal of the predictive value].

Science.gov (United States)

Köthe, L; Radke, J

2010-06-01

In cases of unclear depression of conciousness, arrhythmia and symptoms of cardiac insufficiency inadvertent carbon monoxide intoxication should always be taken into consideration. Rapid diagnosis of acute carbon monoxide intoxication with mostly unspecific symptoms requires an immediate supply of high dose oxygen which enables a distinct reduction of mortality and long-term morbidity. Levels of carboxyhemoglobin, however, should not be used as a parameter to decide whether to supply normobaric or the more efficient hyperbaric oxygen. There is no sufficient coherence between carboxyhemoglobin blood levels and clinical symptoms. Increased carboxyhemoglobin concentrations help to diagnose acute carbon monoxide intoxication but do not allow conclusions to be drawn about possible long-term neuropsychiatric or cardiac consequences.

Increased carboxyhemoglobin in adult falciparum malaria is associated with disease severity and mortality.

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Yeo, Tsin W; Lampah, Daniel A; Kenangalem, Enny; Tjitra, Emiliana; Price, Ric N; Anstey, Nicholas M

2013-09-01

Heme oxygenase 1 expression is increased in pediatric patients with malaria. The carboxyhemoglobin level (a measure of heme oxygenase 1 activity) has not been assessed in adult patients with malaria. Results of pulse co-oximetry revealed that the mean carboxyhemoglobin level was elevated in 29 Indonesian adults with severe falciparum malaria (10%; 95% confidence interval [CI], 8%-13%) and in 20 with severe sepsis (8%; 95% CI, 5%-12%), compared with the mean levels in 32 patients with moderately severe malaria (7%; 95% CI, 5%-8%) and 36 controls (3.6%; 95% CI, 3%-5%; P carboxyhemoglobin level was associated with an increased odds of death among patients with severe malaria (odds ratio, 1.2 per percentage point increase; 95% CI, 1.02-1.5). While also associated with severity and fatality, methemoglobin was only modestly increased in patients with severe malaria. Increased carboxyhemoglobin levels during severe malaria and sepsis may exacerbate organ dysfunction by reducing oxygen carriage and cautions against the use of adjunctive CO therapy, which was proposed on the basis of mouse models.

Relation of whole blood carboxyhemoglobin concentration to ambient carbon monoxide exposure estimated using regression.

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Rudra, Carole B; Williams, Michelle A; Sheppard, Lianne; Koenig, Jane Q; Schiff, Melissa A; Frederick, Ihunnaya O; Dills, Russell

2010-04-15

Exposure to carbon monoxide (CO) and other ambient air pollutants is associated with adverse pregnancy outcomes. While there are several methods of estimating CO exposure, few have been evaluated against exposure biomarkers. The authors examined the relation between estimated CO exposure and blood carboxyhemoglobin concentration in 708 pregnant western Washington State women (1996-2004). Carboxyhemoglobin was measured in whole blood drawn around 13 weeks' gestation. CO exposure during the month of blood draw was estimated using a regression model containing predictor terms for year, month, street and population densities, and distance to the nearest major road. Year and month were the strongest predictors. Carboxyhemoglobin level was correlated with estimated CO exposure (rho = 0.22, 95% confidence interval (CI): 0.15, 0.29). After adjustment for covariates, each 10% increase in estimated exposure was associated with a 1.12% increase in median carboxyhemoglobin level (95% CI: 0.54, 1.69). This association remained after exclusion of 286 women who reported smoking or being exposed to secondhand smoke (rho = 0.24). In this subgroup, the median carboxyhemoglobin concentration increased 1.29% (95% CI: 0.67, 1.91) for each 10% increase in CO exposure. Monthly estimated CO exposure was moderately correlated with an exposure biomarker. These results support the validity of this regression model for estimating ambient CO exposures in this population and geographic setting.

Carbon monoxide uptake and the resulting carboxyhemoglobin in man

Energy Technology Data Exchange (ETDEWEB)

Hauck, H.; Neuberger, M.

1984-01-01

In order to calculate the carboxyhemoglobin concentration in human blood under various circumstances and for particular groups or individuals, the model proposed originally by Coburn and coworkers in a slightly revised form was tested. The relevant breathing parameters were measured as minute averages and used for computation of COHb time course. At the same time blood samples were taken and analyzed for carboxyhemoglobin. For four different subjects, various breathing conditions and work rates the average deviation of experimental data from theoretical predictions is 7.4%. Some data are presented graphically. Excellent conformity of all the results indicate that the model is suitable to show the influence of most physiological and breathing parameters on the dynamics of carbon monxide uptake.

Utility of the Measurement of Carboxyhemoglobin Level at the Site of Acute Carbon Monoxide Poisoning in Rural Areas

OpenAIRE

Onodera, Makoto; Fujino, Yasuhisa; Kikuchi, Satoshi; Sato, Masayuki; Mori, Kiyofumi; Beppu, Takaaki; Inoue, Yoshihiro

2016-01-01

Objective. This study examined the hypothesis that correlations exist between the carbon monoxide exposure time and the carboxyhemoglobin concentration at the site of carbon monoxide poisoning, using a pulse carbon monoxide oximeter in rural areas or the carboxyhemoglobin concentration measured at a given medical institution. Background. In previous studies, no definitive relationships between the arterial blood carboxyhemoglobin level and the severity of carbon monoxide poisoning have been o...

Blood lead and carboxyhemoglobin levels in chainsaw operators.

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van Netten, C; Brubaker, R L; Mackenzie, C J; Godolphin, W J

1987-06-01

Fallers in the British Columbia west coast lumber industry often work in climatic and local conditions where little ventilation in their immediate environment is possible. Under these conditions carbon monoxide (CO) and lead fumes from exhaust gases could build up and become a serious occupational hazard. This study monitored the environmental exposure of six fallers to carbon monoxide, nitrogen oxides, and lead under conditions where buildup of these agents would be expected. At the same time blood samples were taken to correlate these environmental concentrations to carboxyhemoglobin (COHb) and blood lead levels. Although there was a highly significant difference between the fallers and the controls regarding the exposure to CO and lead as well as their corresponding COHb and blood lead levels, the environmental and blood concentration of the agents in question did not exceed the maximum allowable concentrations. Temporary short fluctuations in carboxyhemoglobin levels were not monitored in this study and cannot be ruled out as a potential occupational hazard.

Blood lead and carboxyhemoglobin levels in chainsaw operators

Energy Technology Data Exchange (ETDEWEB)

van Netten, C.; Brubaker, R.L.; Mackenzie, C.J.; Godolphin, W.J.

1987-06-01

Fallers in the British Columbia west coast lumber industry often work in climatic and local conditions where little ventilation in their immediate environment is possible. Under these conditions carbon monoxide (CO) and lead fumes from exhaust gases could build up and become a serious occupational hazard. This study monitored the environmental exposure of six fallers to carbon monoxide, nitrogen oxides, and lead under conditions where buildup of these agents would be expected. At the same time blood samples were taken to correlate these environmental concentrations to carboxyhemoglobin (COHb) and blood lead levels. Although there was a highly significant difference between the fallers and the controls regarding the exposure to CO and lead as well as their corresponding COHb and blood lead levels, the environmental and blood concentration of the agents in question did not exceed the maximum allowable concentrations. Temporary short fluctuations in carboxyhemoglobin levels were not monitored in this study and cannot be ruled out as a potential occupational hazard.

False elevation of carboxyhemoglobin: case report.

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Mehrotra, Shruti; Edmonds, Marcia; Lim, Rodrick K

2011-02-01

Carbon monoxide toxicity in infants and children, like adults, produce nonspecific symptoms with normal vital signs necessitating the serum measurement of carboxyhemoglobin (COHb). In infants, the COHb may be falsely elevated. Our goal was to report a case of suspected carbon monoxide toxicity in an infant and the likely cause of the falsely elevated serum COHb. A previously healthy 3-month-old girl presented to the pediatric emergency department (ED) with smoke inhalation from a defective furnace. She was asymptomatic. On examination, she was alert, with Glasgow Coma Scale of 15 and normal vital signs. Cardiorespiratory and neurological examinations were completely normal. Because of concern regarding carbon monoxide poisoning, she was treated with normobaric oxygen therapy. Initial and subsequent serum COHb levels were persistently elevated, despite treatment and the infant appearing clinically well. As such, she had a prolonged stay in the ED. Further investigations found that fetal hemoglobin interferes with the spectrophotometric method used to analyze serum COHb levels. Carboxyhemoglobin serum level, in infants, may be falsely elevated due to the fetal hemoglobin interfering with standard methods of analysis. Knowledge of the false elevation using standard spectrophotometric methods of COHb in clinically well-appearing infants can decrease unnecessary oxygen therapy and monitoring time in the ED.

The Influence of Smoking on the Variations in Carboxyhemoglobin and Methemoglobin During Urologic Surgery.

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Gavrilovska-Brzanov, Aleksandra; Shosholcheva, Mirjana; Kuzmanovska, Biljana; Kartalov, Andrijan; Mojsova-Mijovska, Maja; Jovanovski-Srceva, Marija; Taleska, Gordana; Brzanov, Nikola; Simeonov, Risto; Miceska, Maja Slaninka

2017-06-01

Surgery is supposed to modulate the production of carbon monoxide by the reduction of heme oxygenase activity or transcriptional regulation of inducible heme oxygenase. On the other hand, the inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Furthermore, methemoglobin is maintained at a constant level. However, excessive production of methemoglobin relative to total methemoglobin reductase activity results in methemoglobin increase. The aim of our study was to investigate the perioperative variations of carboxyhemoglobin and methemoglobin during urologic surgeries, and at the same time to evaluate the changes in methemoglobin as a possible indicator of nitric oxide generation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemoglobin and methemoglobin and the influence of blood transfusion on their changes. The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18-60 years without any history of respiratory disease, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels were determined preoperatively, after preoxygenation, and postoperatively. COHb levels were decreased postoperatively in both groups. The average values of COHb between the two groups were statistically significantly different (p=0.00). MetHb levels increased postoperatively in the group of smokers and decreased in the group of non-smokers. There were no statistically significant differences in the average postoperative MetHb levels between the two groups. Changes in carboxyhemoglobin and methemoglobin concentrations in arterial blood occur during urologic surgery, although these amplitudes are small when compared with carbon monoxide intoxication and methemoglobinemia. It is likely that organ

Environmental variables and levels of exhaled carbon monoxide and carboxyhemoglobin in elderly people taking exercise.

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Salicio, Marcos Adriano; Mana, Viviane Aparecida Martins; Fett, Waléria Christiane Rezende; Gomes, Luciano Teixeira; Botelho, Clovis

2016-04-01

This article aims to analyze levels of exhaled carbon monoxide, carboxyhemoglobinand cardiopulmonary variables in old people practicing exercise in external environments, and correlate them with climate and pollution factors. Temporal ecological study with118 active elderly people in the city of Cuiabá, in the state of Mato Grosso, Brazil. Data were obtained on use of medication, smoking, anthropometric measurements, spirometry, peak flow, oxygen saturation, heart rate, exhaled carbon monoxide, carboxyhemoglobin, climate, number of farm fires and pollution. Correlations were found between on the one hand environmental temperature, relative humidity of the air and number of farmers' fires, and on the other hand levels of carbon monoxide exhaled and carboxyhemoglobin (p carboxyhemoglobin and heart rate. There is thus a need for these to be monitored during exercise. The use of a carbon monoxide monitor to evaluate exposure to pollutants is suggested.

In vivo detection of hemoglobin oxygen saturation and carboxyhemoglobin saturation with multiwavelength photoacoustic microscopy.

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Chen, Zhongjiang; Yang, Sihua; Xing, Da

2012-08-15

A method for noninvasively detecting hemoglobin oxygen saturation (SO2) and carboxyhemoglobin saturation (SCO) in subcutaneous microvasculature with multiwavelength photoacoustic microscopy is presented. Blood samples mixed with different concentrations of carboxyhemoglobin were used to test the feasibility and accuracy of photoacoustic microscopy compared with the blood-gas analyzer. Moreover, fixed-point detection of SO2 and SCO in mouse ear was obtained, and the changes from normoxia to carbon monoxide hypoxia were dynamically monitored in vivo. Experimental results demonstrate that multiwavelength photoacoustic microscopy can detect SO2 and SCO, which has future potential clinical applications.

No correlation between initial arterial carboxyhemoglobin level and degree of lung injury following ovine burn and smoke inhalation.

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Lange, Matthias; Cox, Robert A; Traber, Daniel L; Hamahata, Atsumori; Nakano, Yoshimitsu; Traber, Lillian D; Enkhbaatar, Perenlei

2014-04-01

Fire victims often suffer from burn injury and concomitant inhalation trauma, the latter significantly contributing to the morbidity and mortality in these patients. Measurement of blood carboxyhemoglobin levels has been proposed as a diagnostic marker to verify and, perhaps, quantify the degree of lung injury following inhalation trauma. However, this correlation has not yet been sufficiently validated. A total of 77 chronically instrumented sheep received sham injury, smoke inhalation injury, or combined burn and inhalation trauma following an established protocol. Arterial carboxyhemoglobin concentrations were determined directly after injury and correlated to several clinical and histopathological determinants of lung injury that were detected 48 hours post-injury. The injury induced severe impairment of pulmonary gas exchange and increases in transvascular fluid flux, lung water content, and airway obstruction scores. No significant correlations were detected between initial carboxyhemoglobin levels and all measured clinical and histopathological determinants of lung injury. In conclusion, the amount of arterial carboxyhemoglobin concentration cannot predict the degree of lung injury at 48 hours after ovine burn and smoke inhalation trauma.

A Pilot Study of Inhaled CO Therapy in Neonatal Hypoxia-Ischemia: Carboxyhemoglobin Concentrations and Brain Volumes.

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Douglas-Escobar, Martha; Mendes, Monique; Rossignol, Candace; Bliznyuk, Nikolay; Faraji, Ariana; Ahmad, Abdullah S; Doré, Sylvain; Weiss, Michael D

2018-01-01

Objective: The objective of this pilot study was to start evaluating the efficacy and the safety (i.e., carboxyhemoglobin concentration of carbon monoxide (CO)) as a putative neuroprotective therapy in neonates. Study Design: Neonatal C57BL/6 mice were exposed to CO at a concentration of either 200 or 250 ppm for a period of 1 h. The pups were then sacrificed at 0, 10, 20, 60, 120, 180, and 240 min after exposure to either concentration of CO, and blood was collected for analysis of carboxyhemoglobin. Following the safety study, 7-day-old pups underwent a unilateral carotid ligation. After recovery, the pups were exposed to a humidified gas mixture of 8% oxygen and 92% nitrogen for 20 min in a hypoxia chamber. One hour after the hypoxia exposure, the pups were randomized to one of two groups: air (HI+A) or carbon monoxide (HI+CO). An inhaled dose of 250 ppm of CO was administered to the pups for 1 h per day for a period of 3 days. At 7 days post-injury, the pups were sacrificed and the brains analyzed for cortical and hippocampal volumes. Results: CO exposure at 200 and 250 ppm produced a peak carboxyhemoglobin concentration of 21.52 ± 1.18% and 27.55 ± 3.58%, respectively. The carboxyhemoglobin concentrations decreased rapidly, reaching control concentrations by 60 min post exposure. At 14 days of age (7 days post injury), the HI+CO (treated with 1 h per day of 250 ppm of CO for 3 days post injury) had significant preservation of the ratio of ipsilateral to contralateral cortex (median 1.07, 25% 0.97, 75% 1.23, n = 10) compared the HI+A group ( p carboxyhemoglobin concentrations which would induce acute neurologic abnormalities and was effective in preserving cortical volumes following hypoxic-ischemic injury.

Alarming levels of carboxyhemoglobin in banked blood.

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Ehlers, Melissa; Labaze, Georges; Hanakova, Marcela; McCloskey, David; Wilner, George

2009-06-01

To determine the level of carboxyhemoglobin found in banked blood in the Albany, NY region. A retrospective descriptive analysis of carboxyhemoglobin (COHb) levels in a series of packed red blood cell (PRBC) units. The blood bank of a university tertiary care hospital in Albany, NY. All PRBC units considered for possible use in pediatric cardiac surgery were first analyzed for levels of COHb. Only those units with COHb levels of <1.5% were deemed acceptable for use during pediatric cardiac surgery. A sample of blood drawn from the sample side arm of each PRBC unit was analyzed on a Chiron 855 Blood Gas Analyzer (Chiron Inc, Emeryville, CA, now Siemens/Bayer RapidLab 865) to determine the level of COHb. The average COHb level was 0.78% (standard deviation +/- 1.48%), and out of the 468 units tested, 48 (10.3%) had COHb levels of 1.5% or greater. The highest recorded COHb level was 12%. The transfusion of PRBC units may artificially elevate readings of COHb and cause confusion over possible causes. Certain high-risk populations (eg, cyanotic neonates undergoing cardiopulmonary bypass) may be especially at risk. Although levels of COHb in the US blood supply are dropping, institutions may want to consider analyzing COHb levels in their PRBC units before transfusion in these high-risk populations.

Elevated carboxyhemoglobin: sources of carbon monoxide exposure.

Science.gov (United States)

Buchelli Ramirez, Herminia; Fernández Alvarez, Ramón; Rubinos Cuadrado, Gemma; Martinez Gonzalez, Cristina; Rodriguez Jerez, Francisco; Casan Clara, Pere

2014-11-01

Inhalation of carbon monoxide (CO) can result in poisoning, with symptoms ranging from mild and nonspecific to severe, or even death. CO poisoning is often underdiagnosed because exposure to low concentrations goes unnoticed, and threshold values for normal carboxyhemoglobin vary according to different authors. The aim of our study was to analyze carboxyhemoglobin (COHb) levels in an unselected population and detect sources of CO exposure In a cross-sectional descriptive study, we analyzed consecutive arterial blood gas levels processed in our laboratory. We selected those with COHb≥2.5% in nonsmokers and ≥5% in smokers. In these cases a structured telephone interview was conducted. Elevated levels of COHb were found in 64 (20%) of 306 initial determinations. Of these, data from 51 subjects aged 65±12 years, 31 (60%) of which were men, were obtained. Mean COHb was 4.0%. Forty patients (78%) were non-smokers with mean COHb of 3.2%, and 11 were smokers with COHb of 6.7%. In 45 patients (88.2%) we detected exposure to at least one source of ambient CO other than cigarette smoke. A significant proportion of individuals from an unselected sample had elevated levels of COHb. The main sources of CO exposure were probably the home, so this possibility should be explored. The population should be warned about the risks and encouraged to take preventive measures. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

A Pilot Study of Inhaled CO Therapy in Neonatal Hypoxia-Ischemia: Carboxyhemoglobin Concentrations and Brain Volumes

Directory of Open Access Journals (Sweden)

Martha Douglas-Escobar

2018-05-01

Full Text Available Objective: The objective of this pilot study was to start evaluating the efficacy and the safety (i.e., carboxyhemoglobin concentration of carbon monoxide (CO as a putative neuroprotective therapy in neonates.Study Design: Neonatal C57BL/6 mice were exposed to CO at a concentration of either 200 or 250 ppm for a period of 1 h. The pups were then sacrificed at 0, 10, 20, 60, 120, 180, and 240 min after exposure to either concentration of CO, and blood was collected for analysis of carboxyhemoglobin. Following the safety study, 7-day-old pups underwent a unilateral carotid ligation. After recovery, the pups were exposed to a humidified gas mixture of 8% oxygen and 92% nitrogen for 20 min in a hypoxia chamber. One hour after the hypoxia exposure, the pups were randomized to one of two groups: air (HI+A or carbon monoxide (HI+CO. An inhaled dose of 250 ppm of CO was administered to the pups for 1 h per day for a period of 3 days. At 7 days post-injury, the pups were sacrificed and the brains analyzed for cortical and hippocampal volumes.Results: CO exposure at 200 and 250 ppm produced a peak carboxyhemoglobin concentration of 21.52 ± 1.18% and 27.55 ± 3.58%, respectively. The carboxyhemoglobin concentrations decreased rapidly, reaching control concentrations by 60 min post exposure. At 14 days of age (7 days post injury, the HI+CO (treated with 1 h per day of 250 ppm of CO for 3 days post injury had significant preservation of the ratio of ipsilateral to contralateral cortex (median 1.07, 25% 0.97, 75% 1.23, n = 10 compared the HI+A group (p < 0.05.Conclusion: CO exposure of 250 ppm did not reach carboxyhemoglobin concentrations which would induce acute neurologic abnormalities and was effective in preserving cortical volumes following hypoxic-ischemic injury.

Stability of carboxyhemoglobin in stored and mailed blood samples.

Science.gov (United States)

Hampson, Neil B

2008-02-01

Elevated blood carboxyhemoglobin (COHb) levels are used to confirm a clinical diagnosis of exposure to carbon monoxide (CO) and, in some instances, assess severity of poisoning. However, many hospital laboratories cannot measure COHb because they do not have CO-oximeters. In such instances, blood samples are often sent to outside laboratories or with a transported patient for measurement at the receiving hospital. This study was conducted to assess the stability of COHb in stored and mailed blood samples anticoagulated with heparin. Adult human blood was drawn into standard sample tubes anticoagulated with sodium heparin. Carbon monoxide gas was infused to raise the COHb level to 25% to 35%. Samples were then refrigerated or stored at room temperature, and serial COHb determinations were performed for 28 days. Additional samples were measured after being mailed locally or across the United States and back. No significant changes in COHb levels were seen in samples stored either in refrigeration or at room temperature over a period of 28 days or in samples shipped without refrigeration locally or across the United States. Carboxyhemoglobin levels in whole blood samples anticoagulated with heparin are stable with or without refrigeration for up to 4 weeks. If COHb measurement capability is not available, such samples may be shipped or transported with patients with confidence that the COHb level will be stable when measured at a later time.

Carboxyhemoglobin and methemoglobin in asthma.

Science.gov (United States)

Naples, Robert; Laskowski, Dan; McCarthy, Kevin; Mattox, Emmea; Comhair, Suzy A A; Erzurum, Serpil C

2015-04-01

Nitric oxide (NO) and carbon monoxide (CO) are synthesized at high levels in asthmatic airways. NO can oxidize hemoglobin (Hb) to methemoglobin (MetHb). CO binds to heme to produce carboxyhemoglobin (COHb). We hypothesized that MetHb and COHb may be increased in asthma. COHb, MetHb, and Hb were measured in venous blood of healthy controls (n = 32) and asthmatics (n = 31). Arterial COHb and oxyhemoglobin were measured by pulse CO-oximeter. Hb, oxyhemoglobin, and deoxyhemoglobin were similar among groups, but arterial COHb was higher in asthmatics than controls (p = 0.04). Venous COHb was similar among groups, and thus, arteriovenous COHb (a-v COHb) concentration difference was greater in asthma compared with controls. Venous MetHb was lower in asthma compared to controls (p = 0.01) and correlated to venous NO (p = 0.009). The greater a-v COHb in asthma suggests CO offloading to tissues, but lower than normal MetHb suggests countermeasures to avoid adverse effects of high NO on gas transfer.

Masimo Rad-57 Pulse CO-Oximeter for noninvasive carboxyhemoglobin measurement.

Science.gov (United States)

Suner, Selim; McMurdy, John

2009-03-01

Noninvasive methods of body fluid chemical measurement have been expanding. New technologies are enabling the quantification of different compounds in the blood and interstitial tissues. One example of this is the pulse oximeter, which has facilitated the measurement of oxyhemoglobin rapidly and reliably without the requirement of blood-draws. The Masimo Rad-57 Pulse CO-Oximeter expanded the capabilities of pulse-oximetry to include measurements of carboxyhemoglobin and methemoglobin. This innovation has revolutionized the paradigm for detection of patients with CO poisoning. Previously, clinicians relied on historical information and patient signs and symptoms pointing to the possibility of CO exposure or toxicity. Only then would a blood test be ordered to measure carboxyhemoglobin levels. Since the presentation of CO poisoning is nonspecific and overlaps with many other conditions, and since the presence of environmental CO is often unknown, the detection of this condition was only possible in cases where the presence of CO was obvious or where the symptoms were severe. We now know, from studies conducted using the Rad-57, the only US FDA-approved device for noninvasive measurement of SpCO, that there are a significant number of patients who experience CO exposure but are nonsymptomatic. The Rad-57 provides a clinical justification for screening in the healthcare setting to identify patients with significant CO exposure who would otherwise be undetected.

Irradiation of oxyhemoglobin and carboxyhemoglobin by fast neutrons

International Nuclear Information System (INIS)

AbdelBaset, M.S.; Salama, A.A.

1991-01-01

Oxyhemoglobin (Hbo 2 ) and carboxyhemoglobin (HbCO) (2.6x10 - 5 M) were subjected to Cf neutron fluences in the range of 10 - 10 n/cm . Irradiation caused partial conversion of oxyhemoglobin to methemoglobin according to the exposure doses. Also, the results indicated that the exposure of HbCO to neutrons leads to the cleavage of iron porphyrin-CO to free CO. After cleavage of 100% CO, the effect of neutrons is devoted to the oxidation of hemoglobin to methemoglobin. From the results presented in this study, it is concluded that HbCO is more radioresistant than HbO 2 . The main target in the case of HbCO is the iron-porphyrin-CO.2 tab.3 fig

A fluctuating quantum model of the CO vibration in carboxyhemoglobin.

Science.gov (United States)

Falvo, Cyril; Meier, Christoph

2011-06-07

In this paper, we present a theoretical approach to construct a fluctuating quantum model of the CO vibration in heme-CO proteins and its interaction with external laser fields. The methodology consists of mixed quantum-classical calculations for a restricted number of snapshots, which are then used to construct a parametrized quantum model. As an example, we calculate the infrared absorption spectrum of carboxy-hemoglobin, based on a simplified protein model, and found the absorption linewidth in good agreement with the experimental results. © 2011 American Institute of Physics

Resonance Raman spectroscopy in the picosecond time scale: the carboxyhemoglobin photointermediate

International Nuclear Information System (INIS)

Terner, J.; Spiro, T.G.; Nagumo, M.; Nicol, M.F.; El-Sayed, M.A.

1980-01-01

A picosecond resonance Raman detection technique is described. The technique is described as specifically applied to the analysis of carboxyhemoglobin (COHb). Irradiaton of COHb with a tightly focused laser produced three distinct bands between 1540 and 1620cm -1 that are distinct from bands of COHb or deoxyHb, and the bands are attributed to an intermediate in the photolysis of COHb which develops within 30ps of the excitation. Computer subtraction of the COHb spectrum yielded a spectrum of the photointermediate

Study of photodissociation parameters of carboxyhemoglobin

International Nuclear Information System (INIS)

Kuz'min, V V; Salmin, V V; Provorov, A S; Salmina, A B

2008-01-01

The general properties of photodissociation of carboxyhemoglobin (HbCO) in buffer solutions of whole human blood are studied by the flash photolysis method on a setup with intersecting beams. It is shown that the efficiency of photoinduced dissociation of the HbCO complex virtually linearly depends on the photolytic irradiation intensity for the average power density not exceeding 45 mW cm -2 . The general dissociation of the HbCO complex in native conditions occurs in a narrower range of values of the saturation degree than in model experiments with the hemoglobin solution. The dependence of the pulse photolysis efficiency of HbCO on the photolytic radiation wavelength in the range from 550 to 585 nm has a broad bell shape. The efficiency maximum corresponds to the electronic Q transition (porphyrin π-π* absorption) in HbCO at a wavelength of 570 nm. No dissociation of the complex was observed under given experimental conditions upon irradiation of solutions by photolytic radiation at wavelengths above 585 nm. (laser applications and other topics in quantum electronics)

Validation of a spectrophotometric method for quantification of carboxyhemoglobin.

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Luchini, Paulo D; Leyton, Jaime F; Strombech, Maria de Lourdes C; Ponce, Julio C; Jesus, Maria das Graças S; Leyton, Vilma

2009-10-01

The measurement of carboxyhemoglobin (COHb) levels in blood is a valuable procedure to confirm exposure to carbon monoxide (CO) either for forensic or occupational matters. A previously described method using spectrophotometric readings at 420 and 432 nm after reduction of oxyhemoglobin (O(2)Hb) and methemoglobin with sodium hydrosulfite solution leads to an exponential curve. This curve, used with pre-established factors, serves well for lower concentrations (1-7%) or for high concentrations (> 20%) but very rarely for both. The authors have observed that small variations on the previously described factors F1, F2, and F3, obtained from readings for 100% COHb and 100% O(2)Hb, turn into significant changes in COHb% results and propose that these factors should be determined every time COHb is measured by reading CO and O(2) saturated samples. This practice leads to an increase in accuracy and precision.

[Effects of a smoking cessation education on smoking cessation, endothelial function, and serum carboxyhemoglobin in male patients with variant angina].

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Cho, Sook Hee

2012-04-01

The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina. A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups. Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group. The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.

Cerebral blood volume reactivity to hypercapnia measured with 11C-labelled carboxyhemoglobin and positron emission tomography. Chapter 8

International Nuclear Information System (INIS)

Kanno, Iwao; Uemera, Kazuo; Murakami, Matsutaro; Shishido, Fumio; Tomura, Noriaki

1988-01-01

The purpose of the present study to examine the regionality of the CBV reactivity to changes in PaCO2 employing 11C-labelled carboxyhemoglobin and positron emission tomography (PET). The study was caried out using sequential scans obtained by PET followinng a single administration by the 11CO inhalation method during which activation of either hypercapnia or hypocapnia was induced in the subject. 7 refs.; 6 figs.; 2 tabs

Pulse carboxyhemoglobin-oximetry and cigarette smoking.

Science.gov (United States)

Sokolova-Djokić, L; Milosević, S; Skrbić, R; Salabat, R; Voronov, G; Igić, R

2011-01-01

We used a pulse carbon monoxide (CO)-oximeter to measure the levels of carboxyhemoglobin (COHb) in smokers and non-smokers. Our goal was to determine if this device could not only define smoking status, but also to increase accuracy of self-reported data at various surveys on smoking. Thirty-four healthy volunteers participated in this study. Twenty-two of them were current daily smokers; 12 participants were non-smokers who lived alone or with a nonsmoker, and who worked in non-smoking environment. Nicotine dependency level was determined by the modified Fagerstrom questionnaire. Blood COHb levels were measured with a pulse CO-oximeter (Masimo, Radical 7). The COHb levels in both moderate/heavy smokers and light smokers increased significantly after they smoked a single cigarette. This increase persisted for more than 6 h in the moderate/heavy smokers, while in the light smokers COHb levels returned to the baseline level after one hour. The pulse rate of all smokers increased significantly 20 min after smoking. We conclude that the CO-oximeter can detect smoking by moderate/heavy smokers and light smokers if they smoked 6 h or 20 min earlier, respectively. We concluded that it could be used as a validation test for smoking at the time of admission to the surgical facility and to increase smoking abstinence during preoperative and postoperative periods. This noninvasive, simple and inexpensive test may also be used at various surveys to increase accuracy of self-reports on smoking.

Molecular dynamics simulations indicate that deoxyhemoglobin, oxyhemoglobin, carboxyhemoglobin, and glycated hemoglobin under compression and shear exhibit an anisotropic mechanical behavior.

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Yesudasan, Sumith; Wang, Xianqiao; Averett, Rodney D

2018-05-01

We developed a new mechanical model for determining the compression and shear mechanical behavior of four different hemoglobin structures. Previous studies on hemoglobin structures have focused primarily on overall mechanical behavior; however, this study investigates the mechanical behavior of hemoglobin, a major constituent of red blood cells, using steered molecular dynamics (SMD) simulations to obtain anisotropic mechanical behavior under compression and shear loading conditions. Four different configurations of hemoglobin molecules were considered: deoxyhemoglobin (deoxyHb), oxyhemoglobin (HbO 2 ), carboxyhemoglobin (HbCO), and glycated hemoglobin (HbA 1C ). The SMD simulations were performed on the hemoglobin variants to estimate their unidirectional stiffness and shear stiffness. Although hemoglobin is structurally denoted as a globular protein due to its spherical shape and secondary structure, our simulation results show a significant variation in the mechanical strength in different directions (anisotropy) and also a strength variation among the four different hemoglobin configurations studied. The glycated hemoglobin molecule possesses an overall higher compressive mechanical stiffness and shear stiffness when compared to deoxyhemoglobin, oxyhemoglobin, and carboxyhemoglobin molecules. Further results from the models indicate that the hemoglobin structures studied possess a soft outer shell and a stiff core based on stiffness.

Increased carboxyhemoglobin level during liver resection with inflow occlusion.

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Godai, Kohei; Hasegawa-Moriyama, Maiko; Kuniyoshi, Tamotsu; Matsunaga, Akira; Kanmura, Yuichi

2013-04-01

Controlling stress responses associated with ischemic changes due to bleeding and ischemia/reperfusion injury is essential for anesthetic management. Endogenous carboxyhemoglobin (COHb) is produced in the oxidative degradation of heme proteins by the stress-response enzyme heme oxygenase. Although the COHb level is elevated in critically ill patients, changes in endogenous COHb during anesthesia have not been well investigated. Therefore, we evaluated changes in endogenous COHb levels in patients undergoing liver resections with inflow occlusion. Levels of COHb were significantly increased after the Pringle maneuver. The inflow occlusion time in patients with increased COHb after the Pringle maneuver (∆COHb > 0.3 %) was significantly longer than in patients without increased COHb (∆COHb < 0.3 %) (P = 0.01). In addition, COHb changes were correlated with inflow occlusion time (P = 0.005, R(2) = 0.21). Neither total blood loss, transfusion volume of packed red blood cells, operation time, nor anesthetic time differed between patients with and without increased COHb. The results indicated that endogenous COHb levels were increased by inflow occlusion in patients undergoing liver resections, which suggests that changes in COHb may correlate with hepatic ischemia/reperfusion injury induced by inflow occlusion.

Carboxyhemoglobin - the forgotten parameter of neonatal hyperbilirubinemia.

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Bailey, Douggl G N; Fuchs, Hans; Hentschel, Roland

2017-07-26

Neonatal hyperbilirubinemia is influenced by a wide variety of factors, one of which is hemolysis. Serious hyperbilirubinemia may lead to a kernicterus with detrimental neurologic sequelae. Patients suffering from hemolytic disease have a higher risk of developing kernicterus. Carbon monoxide (CO), a byproduct of hemolysis or heme degradation, was described by Sjöstrand in the 1960s. It is transported as carboxyhemoglobin (COHb) and exhaled through the lungs. We were interested in a potential correlation between COHb and total serum bilirubin (TSB) and the time course of both parameters. We used a point of care (POC) blood gas analyzer and did a retrospective analysis of bilirubin and COHb data collected over a 60-day period. An arbitrary cut-off point set at 2% COHb identified four patients with hemolytic disease of different origins who required phototherapy. In one patient with atypical hemolytic uremic syndrome (aHUS), COHb preceded the rise in bilirubin by about 2 days. Despite this displacement, there was a moderately good correlation of COHb with TSB levels <15 mg/dL (257 μmol/L) (r2: 0.80) and direct bilirubin (r2: 0.78) in the first patient. For all the four patients and all time points the correlation was slightly lower (r2: 0.59). COHb might be useful as a marker for high hemoglobin turnover to allow an earlier identification of newborns at risk to a rapid rise in bilirubin.

Carboxyhemoglobin levels of selected population segments in variously structured and polluted areas of North Rhine-Westphalia

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Roscovanu, A.; Kraemer, U.B.; Baginski, B.; Dolgner, R.

1985-03-01

Measurements of carboxyhemoglobin (COHb)-content from about 13,000 inhabitants of various sites in western North Rhine-Westphalia are presented. Analyses were part of surveys on the effects of air pollution conducted between 1975 and 1980 in five designated, polluted areas. Determinations were executed in the Medical Institute for Environmental Hygiene, Duesseldorf, on behalf of the Ministry of Labor, Health and Social Administration. Analysis of blood samples for CO-content was performed by gas chromatography. Carboxyhemoglobin levels were calculated by reference to the individual hemoglobin levels. These surveys have been conducted during several years and included different seasons. Before 1977, fifty years old men were investigated. Until 1978, sixty years old men were studied. In 1979 and 1980, sixty years old women and ten years old children were additionally incorporated into the survey. Statistical analysis of data included variables which influence personal CO-burden such as smoking, and in the case of non-smokers indoor air exposure through passive smoking, use of gas facilities and heating in the flat, as well as occupational exposure. Besides, the influence of age, sex and location was considered. The average COHb-level of the populations under study was expressed as the median of the distribution. The distribution-free Mann-Whitney U-test served for assessment of differences between groups. As a further parameter, the percentage of the measurements greater than 2,5% COHb was chosen, because it was thought to be more relevant to risk populations, i.e. people suffering from Angina pectoris. As expected, tobacco smoking exerted the greatest influence on COHb-level. In non-smokers a trend, indicating a relationship between indoor air pollution and COHb-content could be observed.

Evaluation of photo destruction of chromophores of heme and globin components in UV-irradiated human carboxyhemoglobin and its electrophoretic fractions

International Nuclear Information System (INIS)

Putintseva, O.V.; Artykhov, V.G.; Kalaeva, E.A.

2000-01-01

The contribution of hem and globin components of electrophoretic fractions of UV-irradiated human carboxyhemoglobin to photo destruction of the protein was studied. The changes observed are the result of summation of some processes unequal in intensity and direction that take place in microgeterogenous media of photo modified protein. Photo sensitivity of hemoproteid in electrophoretic fraction depends on apoprotein condition, whereas the hem photo resistance cannot be the evidence of the photo stability of the whole molecule [ru

Blood carboxyhemoglobin monitoring for evaluation of severity of traumatic shock and reperfusion injuries (analytical review with results of our own observations)

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Kursov, S.V.; Beletskiy, O.V.; Lyzogub, K.I.; Lyzogub, M.V.

2017-01-01

Carbon monoxide (CO) is the native product of organism metabolism. In biology, carbon monoxide is naturally produced by the action of heme oxygenase 1 and 2 on the heme from hemoglobin breakdown. This process produces a certain amount of carboxyhemoglobin in healthy persons, even if they do not breathe any carbon monoxide. CO functions as an endogenous signaling molecule modulates functions of the cardiovascular system, suppresses, reverses, and repairs the damage caused by inflammatory respo...

Accuracy and usefulness of the AVOXimeter 4000 as routine analysis of carboxyhemoglobin.

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Fujihara, Junko; Kinoshita, Hiroshi; Tanaka, Naoko; Yasuda, Toshihiro; Takeshita, Haruo

2013-07-01

The measurement of blood carboxyhemoglobin (CO-Hb) is important to determine the cause of death. The AVOXimeter 4000 (AVOX), a portable CO-oximeter, has the advantages of a low purchase price and operating cost, ease of operation, and rapid results. Little information is available on the usefulness of AVOX in the forensic sample, and the previous study investigated only six samples. Therefore, in this study, we confirmed the usefulness of the AVOX through a comparison of its results with data previously obtained using the double wavelength spectrophotometric method in autopsies. Regression analysis was performed between CO-Hb levels measured by the AVOX and those measured by the conventional double wavelength spectrophotometric method in postmortem blood samples: a significant correlation was observed. This study suggests the usefulness of the AVOX to analyze postmortem blood, and the AVOX is suitable for routine forensic analysis and can be applied at the crime scene. © 2013 American Academy of Forensic Sciences.

Methylene chloride exposure and carboxyhemoglobin levels in cabinetmakers

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Banjoko, Sunny O.; Sridhar Mynapelli, K. C.; Ogunkola, Isiah O.; Masheyi, Olatunde O.

2007-01-01

Methylene chloride (MeCl2) is a clear colorless volatile sweet smelling lipophilic solvent used as a constituent of wood vanishes and paints. Human exposure is mainly due to inhalation and its biotransformation by the hepatic mixed function oxidases (MFO) leads to formation of carbon monoxide (CO). Simultaneous exposure to MeCl2 and increased ambient CO results in undesirably increased carboxyhemoglobin (COHb) formation, which predisposes to carboxyhemoglobinaemia with the central nervous system as the primary target organ of toxicity. In this study, ambient CO levels were determined using a CO personal monitor in different pasts of Ibadan Nigeria and work place microenvironment of 50 Cabinet makers (test group) and 50 volunteer (control) in non-furniture making occupations. Mann Whitney U and Kruskaal Wallis were the statistical methods of analysis used. Questionnaires were administered to both groups carboxyhaemoglobin levels were determined in venous blood drawn from individuals in the two groups by differential spectrophotometric method. Ambient CO levels in Ibadan were observed to be between 4 and 52 ppm with a mean of 20 ppm. Work environment CO levels were significantly higher in test subjects than controls at 5.2 ± 1.08 ppm and 2.08 ± 0.91 ppm respectively (P 0.05). It is therefore imperative to substitute MeCl2 for safer chemicals in wood vanish and paints and the use of protective gas masks and adequate ventilation should be mandatory whenever MeCl2 is used. PMID:21938216

Carboxyhemoglobin formation secondary to nitric oxide therapy in the setting of interstitial lung disease and pulmonary hypertension.

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Ruisi, Phillip; Ruisi, Michael

2011-01-01

Carbon monoxide (CO) has been widely recognized as an exogenous poison, although endogenous mechanisms for its formation involve heme-oxygenase (HO) isoforms, more specifically HO-1, in the setting of oxidative stress such as acute respiratory distress syndrome, sepsis, trauma, and nitric oxide use have been studied. In patients with refractory hypoxemia, inhaled nitric oxide (iNO) therapy is used to selectively vasodilate the pulmonary vasculature and improve ventilation-perfusion match. Inhaled nitric oxide is rapidly inactivated on binding to hemoglobin in the formation of nitrosyl- and methemoglobin in the pulmonary vasculature. Hence, inhaled nitric oxide has minimal systemic dissemination. Several experimental design studies involving lab rats have demonstrated increased levels of carboxyhemoglobin and exhaled CO as a result of nitric oxide HO-1 induction.

PEGylated Bovine Carboxyhemoglobin (SANGUINATE™): Results of Clinical Safety Testing and Use in Patients.

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Abuchowski, A

2016-01-01

Oxygen transfer agents have long been sought as a means to treat hypoxia caused by congenital or acquired conditions. Hemoglobin-based oxygen carriers were in clinical development as blood substitutes, but development was halted due to the finding of significant vasoactivity. Rather than develop a blood substitute, a product for indications characterized by hypoxia is in development. PEGylated bovine carboxyhemoglobin (SANGUINATE™) is both a carbon monoxide releasing molecule and an oxygen transfer agent. It is comprised of three functional components that act to inhibit vasoconstriction, reduce inflammation and optimize the delivery of oxygen. SANGUINATE has the potential to reduce or prevent the effects of ischemia by inhibiting vasoconstriction and re-oxygenating tissue. Phase 1 safety trials in healthy volunteers were completed in 2013. SANGUINATE was shown to be safe and well tolerated with no serious adverse effects. Phase Ib studies have been completed in stable patients with Sickle Cell Disease. SANGUINATE has also been administered to two patients under emergency use protocols. Both patients exhibited improved status following treatment with SANGUINATE.

PEGylated carboxyhemoglobin bovine (SANGUINATE): results of a phase I clinical trial.

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Misra, Hemant; Lickliter, Jason; Kazo, Friedericke; Abuchowski, Abraham

2014-08-01

PEGylated carboxyhemoglobin bovine (SANGUINATE) is a dual action carbon monoxide releasing (CO)/oxygen (O2 ) transfer agent for the treatment of hypoxia. Its components inhibit vasoconstriction, decrease extravasation, limit reactive oxygen species production, enhance blood rheology, and deliver oxygen to the tissues. Animal models of cerebral ischemia, peripheral ischemia, and myocardial ischemia demonstrated SANGUINATE's efficacy in reducing myocardial infarct size, limiting necrosis from cerebral ischemia, and promoting more rapid recovery from hind limb ischemia. In a Phase I trial, three cohorts of eight healthy volunteers received single ascending doses of 80, 120, or 160 mg/kg of SANGUINATE. Two volunteers within each cohort served as a saline control. There were no serious adverse events. Serum haptoglobin decreased, but did not appear to be dose related. The T1/2 was dose dependent and ranged from 7.9 to 13.8 h. In addition to the Phase I trial, SANGUINATE was used under an expanded access emergency Investigational New Drug. SANGUINATE was found to be safe and well tolerated in a Phase I clinical trial, and therefore it will advance into further clinical trials in patients. © 2014 The Authors. Artificial Organs published by Wiley Periodicals, Inc. on behalf of International Center for Artificial Organs and Transplantation (ICAOT).

The rise in carboxyhemoglobin from repeated pulmonary diffusing capacity tests.

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Zavorsky, Gerald S

2013-03-01

The purpose of this study determined the rise in carboxyhemoglobin percentage (COHb) from repeated pulmonary diffusing capacity tests using 5 or 10s single breath-hold maneuvers. Five male and four female non-smokers [baseline COHb=1.2 (SD 0.5%)] performed repeated pulmonary diffusing capacity testing on two separate days. The days were randomized to either repeated 10s (0.28% CO), or 5s (0.28% CO, 55ppm NO) breath-hold maneuvers. Twenty-two 5s breath-hold maneuvers, each separated by 4min rest, raised COHb to 11.1 (1.4)% and minimally raised the methemoglobin percentage (METHb) by 0.3 (0.2)% to a value of 0.8 (0.2)%. After the 22nd test, pulmonary diffusing capacity for carbon monoxide (DLCO) was reduced by about 4mL/min/mmHg, equating to a 0.44% increase in COHb per 5s breath-hold maneuver and a concomitant 0.35mL/min/mmHg decrease in DLCO. Pulmonary diffusing capacity for nitric oxide (DLNO) was not altered after 22 tests. On another day, the 10s single breath-hold maneuver increased COHb by 0.64% per test, and reduced DLCO by 0.44mL/min/mmHg per test. In conclusion, 5s breath-hold maneuvers do not appreciably raise METHb or DLNO, and DLCO is only significantly reduced when COHb is at least 6%. Copyright © 2013 Elsevier B.V. All rights reserved.

Effects of hydroxocobalamin on carboxyhemoglobin measured under physiologic and pathologic conditions.

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Pace, R; Bon Homme, M; Hoffman, R S; Lugassy, D

2014-08-01

Pre-hospital administration of hydroxocobalamin (B12a) is used for empiric treatment of cyanide poisoning because cyanide poisoning is difficult to identify and requires immediate treatment. B12a interferes with the accuracy of several blood laboratory tests. This study aimed to explore how B12a affects carboxyhemoglobin (COHb) measurements in human blood at both physiologic and pathologic COHb levels. Several clinically relevant concentrations of B12a were added to human blood samples containing physiologic (∼ 3%) and pathologic (30% and 50%) COHb levels. We then measured the COHb levels of the samples using two different co-oximeters, the Radiometer ABL 700 and the Rapidpoint 500, and compared to their actual baseline COHb levels. B12a had minimal effects on the COHb measured at both physiologic and pathologic levels when measured on the Radiometer. In contrast, the Rapidpoint B12a caused a dose-dependent decrease in the COHb measured, especially of pathologic COHb levels (∼ 30 and 50%). The magnitude of B12a interference on measured COHb is dependent upon the specific co-oximeter used, the actual COHb level and the serum B12a concentration. These errors may potentially influence clinical decision making and thus affect patient outcomes. Our findings emphasize the importance of measuring COHb levels on blood samples collected prior to B12a administration.

Carboxyhemoglobin Levels Induced by Cigarette Smoking Outdoors in Smokers.

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Schimmel, Jonathan; George, Naomi; Schwarz, John; Yousif, Sami; Suner, Selim; Hack, Jason B

2018-03-01

Non-invasive screening of carboxyhemoglobin saturation (SpCO) in the emergency department to detect occult exposure is increasingly common. The SpCO threshold to consider exposure in smokers is up to 9%. The literature supporting this cutoff is inadequate, and the impact of active smoking on SpCO saturation remains unclear. The primary objective was to characterize baseline SpCO in a cohort of smokers outdoors. Secondary objectives were to explore the impact of active smoking on SpCO and to compare SpCO between smokers and non-smokers. This was a prospective cohort pilot study in two outdoor urban public areas in the USA, in a convenience sample of adult smokers. SpCO saturations were assessed non-invasively before, during, and 2 min after cigarette smoking with pulse CO-oximetry. Analyses included descriptive statistics, correlations, and a generalized estimating equation model. Eighty-five smokers had mean baseline SpCO of 2.7% (SD 2.6) and peak of 3.1% (SD 2.9), while 15 controls had SpCO 1.3% (SD 1.3). This was a significant difference. Time since last cigarette was associated with baseline SpCO, and active smoking increased mean SpCO. There was correlation among individual smokers' SpCO levels before, during, and 2 min after smoking, indicating smokers tended to maintain their baseline SpCO level. This study is the first to measure SpCO during active smoking in an uncontrolled environment. It suggests 80% of smokers have SpCO ≤ 5%, but potentially lends support for the current 9% as a threshold, depending on clinical context.

Prenatal cigarette smoke exposure: Pregnancy outcome and gestational changes in plasma nicotine concentration, hematocrit, and carboxyhemoglobin in a newly standardized rat model

International Nuclear Information System (INIS)

Farkas, Svetlana; Hussein, Jabeen; Ariano, Robert E.; Sitar, Daniel S.; Hasan, Shabih U.

2006-01-01

Epidemiological studies support an association between perinatal cigarette smoke (CS) exposure and a number of severe pre- and postnatal complications. However, the mechanisms through which CS enhances such risks largely remain unknown. One of the reasons for our inability to discover such mechanisms has been the unavailability of a clinically relevant and physiologically concordant animal model. A number of studies have previously used nicotine (Nic) as surrogate for CS. We sought to (1) establish the amount of CS exposure to achieve plasma Nic concentrations observed among moderate to heavy smokers (20-60 ng/ml) (2) investigate the temporal changes in plasma Nic concentrations, carboxyhemoglobin, and hematocrit with advancing pregnancy, and (3) elucidate the effects of CS exposure on pregnancy outcome. Pregnant Sprague-Dawley rats were exposed to various doses of CS or room air (Sham) from days 6 to 21 of gestation. Exposure to 6000 ml/day of CS led to very high plasma Nic concentrations and increased maternal and fetal mortality (P < 0.001). The plasma Nic concentrations remained higher than those observed in moderate smokers until the CS dose was reduced to 1000 ml/day and showed dose-dependent temporal changes with advancing gestational age. Significant increases in carboxyhemoglobin and hematocrit were observed in the CS group as compared with the Sham group (P < 0.001). In addition, prenatally CS exposed fetuses had lower birth weight as compared with the Sham group (P = 0.04). Our current study establishes a newly standardized and physiologically relevant model to investigate the mechanisms of CS-mediated adverse effects during the critical period of fetal development

Evaluating ECG and carboxyhemoglobin changes due to smoking narghile.

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Yıldırım, Fazıl; Çevik, Yunsur; Emektar, Emine; Çorbacıoğlu, Şeref Kerem; Katırcı, Yavuz

2016-10-01

This study aimed to investigate whether increased carboxyhemoglobin (COHB) levels and ECG changes, which associated with fatal ventricular dysrhythmias, including increased QT, P-wave and T peak (Tp)-Tend (Te) dispersion, can be detected after smoking narghile, which is a traditional method of smoking tobacco that is smoked from hookah device. After local ethics committee approval, this prospective study was conducted using healthy volunteer subjects at a "narghile café," which is used by people smoking narghile in an open area. Before beginning to smoke narghile, all subjects' 12-lead electrocardiographs (ECG), measurements of COHB levels, and vital signs were recorded. After smoking narghile for 30 min, the recording of the 12-lead ECGs and the measurements of COHB level and all vital signs were repeated. The mean age of subjects was 26.8 ± 6.2 years (min-max: 18-40), and 28 subjects (84.8%) were male. Before smoking narghile, the median value of subjects' COHB levels was 1.3% (min-max: 0-6), whereas after smoking, the median value of COHB was 23.7% (min-max: 6-44), a statistically significant increase (p < 0.001). Analysis of the subjects' ECG changes after smoking narghile showed that dispersions of QT, QTc, P-wave and Tp-Te were increased, and all changes were statistically significant (p < 0.001 for all parameters). Although, especially among young people, it is commonly thought that smoking narghile has less harmful or toxic effects than other tobacco products. The results of this study and past studies clearly demonstrated that smoking narghile can cause several ECG changes - including increased QT, P-wave and Tp-Te dispersion - which can be associated with ventricular dysrhythmias.

Symptoms of carbon monoxide poisoning do not correlate with the initial carboxyhemoglobin level.

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Hampson, Neil B; Dunn, Susan L

2012-01-01

Symptoms in carbon monoxide (CO) poisoned patients have traditionally been described as being related to corresponding carboxyhemoglobin (COHb) levels without substantive support for the relationship. This study sought to determine whether prospectively collected symptoms correlate with specific COHB level ranges in a large population of CO-poisoned patients. Data from patients reported in the initial two years of operation of the joint UHMS/CDC CO Poisoning Surveillance System were used to compare presenting COHb levels with symptoms collected with a standardized questionnaire. Data from 1,323 CO-poisoned patients referred for hyperbaric oxygen therapy from August 2008 to July 2010 were analyzed with regard to initial COHb level and symptoms. Of approximately 50 categories of symptoms reported, none was associated with a specific range of COHb levels. While symptoms are common in acute CO poisoning, none can be directly correlated to COHb levels, even in a population of more than 1,000 patients. The concept of a table relating specific symptoms to specific COHb levels is invalid. One such table that has often been published comes from a 1923 U.S. government publication and appears to be based at least in part upon the symptoms experienced by three men in a total of 10 low-level laboratory CO exposures.

Carboxyhemoglobin and methemoglobin levels as prognostic markers in acute pulmonary embolism.

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Kakavas, Sotirios; Papanikolaou, Aggeliki; Ballis, Evangelos; Tatsis, Nikolaos; Goga, Christina; Tatsis, Georgios

2015-04-01

Carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels have been associated with a poor outcome in patients with various pathological conditions including cardiovascular diseases. Our aim was to retrospectively assess the prognostic value of arterial COHb and MetHb in patients with acute pulmonary embolism (PE). We conducted a retrospective study of 156 patients admitted in a pulmonary clinic due to acute PE. Measured variables during emergency department evaluation that were retrospectively analyzed included the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in inspired gas, Acute Physiology and Chronic Health Evaluation II score, risk stratification indices, and arterial blood gases. The association between arterial COHb and MetHb levels and disease severity or mortality was evaluated using bivariate tests and logistic regression analysis. Arterial COHb and MetHb levels correlated with Acute Physiology and Chronic Health Evaluation II and pulmonary severity index scores. Furthermore, arterial COHb and MetHb levels were associated with troponin T and N-terminal pro-B-type natriuretic peptide levels. In univariate logistic regression analysis, COHb and MetHb levels were both significantly associated with an increased risk of death. However, in multivariate analysis, only COHb remained significant as an independent predictor of in-hospital mortality. Our preliminary data suggest that arterial COHb and MetHb levels reflect the severity of acute PE, whereas COHb levels are independent predictors of in hospital death in patients in this clinical setting. These findings require further prospective validation. Copyright © 2015 Elsevier Inc. All rights reserved.

The application of extended modified Lambert Beer model for measurement of blood carboxyhemoglobin and oxyhemoglobin saturation

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Audrey Huong

2014-05-01

Full Text Available This work presents the use of extended Modified Lambert Beer (MLB model for accurate and continuous monitoring of percent blood carboxyhemoglobin (COHb (SCO and oxyhemoglobin (OxyHb saturation (SO2 via a fitting procedure. This quantification technique is based on the absorption characteristics of hemoglobin derivatives in the wavelength range of 520–600 nm to give the best estimates of the required parameters. A comparison of the performance of the developed model and MLB law is made using attenuation data from Monte Carlo simulations for a two-layered skin model. The results revealed a lower mean absolute error of 0.4% in the values estimated by the developed model as compared to 10% that is given by the MLB law. This study showed that the discussed approach is able to provide consistent and accurate measurement of blood SO2 and SCO across different skin pigmentations suggesting that it may potentially be used as an alternative means for clinical diagnosis of carbon monoxide (CO poisoning.

Acute respiratory diseases and carboxyhemoglobin status in school children of Quito, Ecuador.

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Estrella, Bertha; Estrella, Ramiro; Oviedo, Jorge; Narváez, Ximena; Reyes, María T; Gutiérrez, Miguel; Naumova, Elena N

2005-05-01

Outdoor carbon monoxide comes mainly from vehicular emissions, and high concentrations occur in areas with heavy traffic congestion. CO binds to hemoglobin, forming carboxyhemoglobin (COHb), and reduces oxygen delivery. We investigated the link between the adverse effects of CO on the respiratory system using COHb as a marker for chronic CO exposure. We examined the relationship between acute respiratory infections (ARIs) and COHb concentrations in school-age children living in urban and suburban areas of Quito, Ecuador. We selected three schools located in areas with different traffic intensities and enrolled 960 children. To adjust for potential confounders we conducted a detailed survey. In a random subsample of 295 children, we determined that average COHb concentrations were significantly higher in children attending schools in areas with high and moderate traffic, compared with the low-traffic area. The percentage of children with COHb concentrations above the safe level of 2.5% were 1, 43, and 92% in low-, moderate-, and high-traffic areas, respectively. Children with COHb above the safe level are 3.25 [95% confidence interval (CI), 1.65-6.38] times more likely to have ARI than children with COHb < 2.5%. Furthermore, with each percent increase in COHb above the safety level, children are 1.15 (95% CI, 1.03-1.28) times more likely to have an additional case of ARI. Our findings provide strong evidence of the relation between CO exposure and susceptibility to respiratory infections.

Acute Respiratory Diseases and Carboxyhemoglobin Status in School Children of Quito, Ecuador

Science.gov (United States)

Estrella, Bertha; Estrella, Ramiro; Oviedo, Jorge; Narváez, Ximena; Reyes, María T.; Gutiérrez, Miguel; Naumova, Elena N.

2005-01-01

Outdoor carbon monoxide comes mainly from vehicular emissions, and high concentrations occur in areas with heavy traffic congestion. CO binds to hemoglobin, forming carboxyhemoglobin (COHb), and reduces oxygen delivery. We investigated the link between the adverse effects of CO on the respiratory system using COHb as a marker for chronic CO exposure. We examined the relationship between acute respiratory infections (ARIs) and COHb concentrations in school-age children living in urban and suburban areas of Quito, Ecuador. We selected three schools located in areas with different traffic intensities and enrolled 960 children. To adjust for potential confounders we conducted a detailed survey. In a random subsample of 295 children, we determined that average COHb concentrations were significantly higher in children attending schools in areas with high and moderate traffic, compared with the low-traffic area. The percentage of children with COHb concentrations above the safe level of 2.5% were 1, 43, and 92% in low-, moderate-, and high-traffic areas, respectively. Children with COHb above the safe level are 3.25 [95% confidence interval (CI), 1.65–6.38] times more likely to have ARI than children with COHb < 2.5%. Furthermore, with each percent increase in COHb above the safety level, children are 1.15 (95% CI, 1.03–1.28) times more likely to have an additional case of ARI. Our findings provide strong evidence of the relation between CO exposure and susceptibility to respiratory infections. PMID:15866771

Elevated carboxyhemoglobin in a marine mammal, the northern elephant seal.

Science.gov (United States)

Tift, Michael S; Ponganis, Paul J; Crocker, Daniel E

2014-05-15

Low concentrations of endogenous carbon monoxide (CO), generated primarily through degradation of heme from heme-proteins, have been shown to maintain physiological function of organs and to exert cytoprotective effects. However, high concentrations of carboxyhemoglobin (COHb), formed by CO binding to hemoglobin, potentially prevent adequate O2 delivery to tissues by lowering arterial O2 content. Elevated heme-protein concentrations, as found in marine mammals, are likely associated with greater heme degradation, more endogenous CO production and, consequently, elevated COHb concentrations. Therefore, we measured COHb in elephant seals, a species with large blood volumes and elevated hemoglobin and myoglobin concentrations. The levels of COHb were positively related to the total hemoglobin concentration. The maximum COHb value was 10.4% of total hemoglobin concentration. The mean (± s.e.m.) value in adult seals was 8.7 ± 0.3% (N=6), while juveniles and pups (with lower heme-protein contents) had lower mean COHb values of 7.6 ± 0.2% and 7.1 ± 0.3%, respectively (N=9 and N=9, respectively). Serial samples over several hours revealed little to no fluctuation in COHb values. This consistent elevation in COHb suggests that the magnitude and/or rate of heme-protein turnover is much higher than in terrestrial mammals. The maximum COHb values from this study decrease total body O2 stores by 7%, thereby reducing the calculated aerobic dive limit for this species. However, the constant presence of elevated CO in blood may also protect against potential ischemia-reperfusion injury associated with the extreme breath-holds of elephant seals. We suggest the elephant seal represents an ideal model for understanding the potential cytoprotective effects, mechanisms of action and evolutionary adaptation associated with chronically elevated concentrations of endogenously produced CO. © 2014. Published by The Company of Biologists Ltd.

Carboxyhemoglobin Formation in Preterm Infants Is Related to the Subsequent Development of Bronchopulmonary Dysplasia.

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Tokuriki, Shuko; Okuno, Takashi; Ohta, Genrei; Ohshima, Yusei

2015-01-01

To evaluate the usefulness of carboxyhemoglobin (CO-Hb) levels as a biomarker to predict the development and severity of bronchopulmonary dysplasia (BPD). Twenty-five infants born at <33 wk of gestational age or with a birth weight of <1,500 g were enrolled. CO-Hb levels were measured between postnatal days 5 and 8, 12 and 15, 19 and 22, and 26 and 29. Urinary levels of 8-hydroxydeoxyguanosine (8-OHdG), advanced oxidation protein products, and Nε-(hexanoyl) lysine were measured between postnatal days 5 and 8 and 26 and 29. Receiver operating characteristic (ROC) analysis was used to compare the biomarkers' predictive values. Compared with infants in the no-or-mild BPD group, infants with moderate-to-severe BPD exhibited higher CO-Hb levels during the early postnatal period and higher 8-OHdG levels between postnatal days 5 and 8. Using ROC analysis to predict the development of moderate-to-severe BPD, the area under the curve (AUC) for CO-Hb levels between postnatal days 5 and 8 was higher than AUCs for the urinary markers. CO-Hb levels during the early postnatal period may serve as a practical marker for evaluating oxidative stress and the severity of subsequently developing BPD.

Carboxyhemoglobin Formation in Preterm Infants Is Related to the Subsequent Development of Bronchopulmonary Dysplasia

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Shuko Tokuriki

2015-01-01

Full Text Available Objective. To evaluate the usefulness of carboxyhemoglobin (CO-Hb levels as a biomarker to predict the development and severity of bronchopulmonary dysplasia (BPD. Methods. Twenty-five infants born at <33 wk of gestational age or with a birth weight of <1,500 g were enrolled. CO-Hb levels were measured between postnatal days 5 and 8, 12 and 15, 19 and 22, and 26 and 29. Urinary levels of 8-hydroxydeoxyguanosine (8-OHdG, advanced oxidation protein products, and Nε-(hexanoyl lysine were measured between postnatal days 5 and 8 and 26 and 29. Receiver operating characteristic (ROC analysis was used to compare the biomarkers’ predictive values. Results. Compared with infants in the no-or-mild BPD group, infants with moderate-to-severe BPD exhibited higher CO-Hb levels during the early postnatal period and higher 8-OHdG levels between postnatal days 5 and 8. Using ROC analysis to predict the development of moderate-to-severe BPD, the area under the curve (AUC for CO-Hb levels between postnatal days 5 and 8 was higher than AUCs for the urinary markers. Conclusions. CO-Hb levels during the early postnatal period may serve as a practical marker for evaluating oxidative stress and the severity of subsequently developing BPD.

Second-hand smoking and carboxyhemoglobin levels in children: a prospective observational study.

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Yee, Branden E; Ahmed, Mohammed I; Brugge, Doug; Farrell, Maureen; Lozada, Gustavo; Idupaganthi, Raghu; Schumann, Roman

2010-01-01

To establish baseline noninvasive carboxyhemoglobin (COHb) levels in children and determine the influence of exposure to environmental sources of carbon monoxide (CO), especially environmental tobacco smoke, on such levels. Second-hand smoking may be a risk factor for adverse outcomes following anesthesia and surgery in children (1) and may potentially be preventable. Parents and their children between the ages of 1-12 were enrolled on the day of elective surgery. The preoperative COHb levels of the children were assessed noninvasively using a CO-Oximeter (Radical-7 Rainbow SET Pulse CO-Oximeter; Masimo, Irvine, CA, USA). The parents were asked to complete an environmental air-quality questionnaire. The COHb levels were tabulated and correlated with responses to the survey in aggregate analysis. Statistical analyses were performed using the nonparametric Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was statistically significant. Two hundred children with their parents were enrolled. Children exposed to parental smoking had higher COHb levels than the children of nonsmoking controls. Higher COHb values were seen in the youngest children, ages 1-2, exposed to parental cigarette smoke. However, these trends did not reach statistical significance, and confidence intervals were wide. This study revealed interesting trends of COHb levels in children presenting for anesthesia and surgery. However, the COHb levels measured in our patients were close to the error margin of the device used in our study. An expected improvement in measurement technology may allow screening children for potential pulmonary perioperative risk factors in the future.

Non-invasive measurements of carboxyhemoglobin and methemoglobin in children with sickle cell disease.

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Caboot, Jason B; Jawad, Abbas F; McDonough, Joseph M; Bowdre, Cheryl Y; Arens, Raanan; Marcus, Carole L; Mason, Thornton B A; Smith-Whitley, Kim; Ohene-Frempong, Kwaku; Allen, Julian L

2012-08-01

Assessment of oxyhemoglobin saturation in patients with sickle cell disease (SCD) is vital for prompt recognition of hypoxemia. The accuracy of pulse oximeter measurements of blood oxygenation in SCD patients is variable, partially due to carboxyhemoglobin (COHb) and methemoglobin (MetHb), which decrease the oxygen content of blood. This study evaluated the accuracy and reliability of a non-invasive pulse co-oximeter in measuring COHb and MetHb percentages (SpCO and SpMet) in children with SCD. We hypothesized that measurements of COHb and MetHb by non-invasive pulse co-oximetry agree within acceptable clinical accuracy with those made by invasive whole blood co-oximetry. Fifty children with SCD-SS underwent pulse co-oximetry and blood co-oximetry while breathing room air. Non-invasive COHb and MetHb readings were compared to the corresponding blood measurements. The pulse co-oximeter bias was 0.1% for COHb and -0.22% for MetHb. The precision of the measured SpCO was ± 2.1% within a COHb range of 0.4-6.1%, and the precision of the measured SpMet was ± 0.33% within a MetHb range of 0.1-1.1%. Non-invasive pulse co-oximetry was useful in measuring COHb and MetHb levels in children with SCD. Although the non-invasive technique slightly overestimated the invasive COHb measurements and slightly underestimated the invasive MetHb measurements, there was close agreement between the two methods. Copyright © 2012 Wiley Periodicals, Inc.

Carboxyhemoglobin levels in medical intensive care patients: a retrospective, observational study.

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Fazekas, Andreas S; Wewalka, Marlene; Zauner, Christian; Funk, Georg-Christian

2012-01-11

Critical illness leads to increased endogenous production of carbon monoxide (CO) due to the induction of the stress-response enzyme, heme oxygenase-1 (HO-1). There is evidence for the cytoprotective and anti-inflammatory effects of CO based on animal studies. In critically ill patients after cardiothoracic surgery, low minimum and high maximum carboxyhemoglobin (COHb) levels were shown to be associated with increased mortality, which suggests that there is an 'optimal range' for HO-1 activity. Our study aimed to test whether this relationship between COHb and outcome exists in non-surgical ICU patients. We conducted a retrospective, observational study in a medical ICU at a university hospital in Vienna, Austria involving 868 critically ill patients. No interventions were undertaken. Arterial COHb was measured on admission and during the course of treatment in the ICU. The association between arterial COHb levels and ICU mortality was evaluated using bivariate tests and a logistic regression model. Minimum COHb levels were slightly lower in non-survivors compared to survivors (0.9%, 0.7% to 1.2% versus 1.2%, 0.9% to 1.5%; P=0.0001), and the average COHb levels were marginally lower in non-survivors compared to survivors (1.5%, 1.2% to 1.8% versus 1.6%, 1.4% to 1.9%, P=0.003). The multivariate logistic regression analysis revealed that the association between a low minimum COHb level and increased mortality was independent of the severity of illness and the type of organ failure. Critically ill patients surviving the admission to a medical ICU had slightly higher minimum and marginally higher average COHb levels when compared to non-survivors. Even though the observed differences are statistically significant, the minute margins would not qualify COHb as a predictive marker for ICU mortality.

The association of physical examination abnormalities and carboxyhemoglobin concentrations in 21 dogs trapped in a kennel fire.

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Ashbaugh, Elizabeth A; Mazzaferro, Elisa M; McKiernan, Brendan C; Drobatz, Kenneth J

2012-06-01

To evaluate physical examination findings and their association with carboxyhemoglobin (COHb) concentrations in 21 dogs that were exposed to smoke during a kennel fire. Twenty-one dogs were exposed to a kennel fire. Physical exam findings, presenting, and posttherapy COHb concentrations as well as therapeutic interventions were evaluated. COHb concentrations upon presentation were increased in all smoke inhalation exposed dogs. These dogs were compared to a small set of clinically normal staff-owned dogs who were not exposed to fire. Physical parameters significantly associated with higher COHb concentrations included lower body temperature, increased respiratory effort, abnormal respiratory auscultation, altered neurologic status, and length of hospital stay. Oxygen therapy resulted in a more rapid decline in COHb concentrations although 5 dogs still had mildly increased COHb concentrations 24-hour postadmission. This study describes the relationship of admitting clinical findings of dogs exposed to a kennel fire with their initial blood COHb concentrations. It also describes the resolution of increased COHb concentrations with use of oxygen therapy and hospitalization. Additionally, COHb concentrations for a control group of dogs was evaluated and compared to the dogs exposed to smoke inhalation. © Veterinary Emergency and Critical Care Society 2012.

The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter.

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Zaouter, Cédrick; Zavorsky, Gerald S

2012-07-01

The pulse CO-oximeter (Rad-57 Masimo Corporation, Irvine, CA) allows non-invasive and instantaneous measurement of carboxyhemoglobin (COHb) and methemoglobin (MetHb) percentage level using a finger probe. However, the accuracy and reliability of the Rad-57 against the gold standard of venous or arterial blood samples have not been clearly established. Thus, the objective of this trial is to evaluate the accuracy and precision of the Rad-57 pulse CO-oximeter by comparing it with venous sampling on the same subjects. Nine healthy subjects were subjected to carbon monoxide such that it raised the COHb to 10-14% on two different days and pooled together. The COHb and MetHb were measured with a blood gas-analyzer and simultaneously with the Rad-57 as the COHb increased from 1.4 to 14%. Results were compared using linear regression and a Bland and Altman method comparison. Mean bias and precision for COHb measured with the Rad-57 was -1% and 2.5%, respectively. The mean bias and precision for MetHb measured with the Rad-57 was 0.0% and 0.3%, respectively. The ability to detect a COHb ≥ 10% occurred in 54% of the samples in which COHb was ≥ 10-14%. In conclusion, the Rad-57 provides a reading that is between -6% and +4% of the true COHb value for 95% of all samples. The Rad-57 seems to be a good substitute as a first screening test of COHb when the pulse CO-oximeter reads <15%. Copyright © 2012 Elsevier B.V. All rights reserved.

Non-invasive carboxyhemoglobin monitoring: screening emergency medical services patients for carbon monoxide exposure.

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Nilson, Douglas; Partridge, Robert; Suner, Selim; Jay, Gregory

2010-01-01

Carbon monoxide (CO) toxicity is a significant health problem. The use of non-invasive pulse CO-oximetry screening in the emergency department has demonstrated that the rapid screening of numerous individuals for CO toxicity is simple and capable of identifying occult cases of CO toxicity. The objective of this study was to extend the use of this handheld device to the prehospital arena, assess carboxyhemoglobin (SpCO) levels in emergency medical services (EMS) patients, and correlate these levels with clinical and demographic data. This was a retrospective, observational, chart review of adult patients transported to hospital emergency departments by urban fire department EMS ambulances during a six-week period. Each ambulance used a non-invasive pulse CO-oximeter (Rad-57, Masimo Inc.) to record patients' COHb concentrations (SpCO) along with the standard EMS assessment data. Spearman's Rank Correlation tests and Student's t-tests were used to analyze the data and calculate relationships between SpCO and other variables (age, gender, respiratory rate, heart rate, mean arterial pressure, and oxygen saturation measured by pulse oximetry). A total of 36.4% of the patients transported during the study had SpCO documented. Of the 1,017 adults included in this group, 11 (1.1%) had an SpCO >15%. There was no correlation between SpCO and heart rate, ventilatory rate, mean arterial pressure, and oxygen saturation. Screening for CO toxicity in the EMS setting is possible, and may aid in the early detection and treatment of CO-poisoned patients.

The Accuracy of Pulse Spectroscopy for Detecting Hypoxemia and Coexisting Methemoglobin or Carboxyhemoglobin.

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Kulcke, Axel; Feiner, John; Menn, Ingolf; Holmer, Amadeus; Hayoz, Josef; Bickler, Philip

2016-06-01

Pulse spectroscopy is a new noninvasive technology involving hundreds of wavelengths of visible and infrared light, enabling the simultaneous quantitation of multiple types of normal and dysfunctional hemoglobin. We evaluated the accuracy of a first-generation pulse spectroscopy system (V-Spec™ Monitoring System, Senspec, Germany) in measuring oxygen saturation (SpO2) and detecting carboxyhemoglobin (COHb) or methemoglobin (MetHb), alone or simultaneously, with hypoxemia. Nineteen volunteers were fitted with V-Spec probes on the forehead and fingers. A radial arterial catheter was placed for blood sampling during (1) hypoxemia with arterial oxygen saturations (SaO2) of 100% to 58.5%; (2) normoxia with MetHb and COHb increased to approximately 10%; (3) 10% COHb or MetHb combined with hypoxemia with SaO2 of 100% to 80%. Standard measures of pulse-oximetry performance were calculated: bias (pulse spectroscopy measured value - arterial measured value) mean ± SD and root-mean-square error (Arms). The SpO2 bias for SaO2 approximately 60% to 100% was 0.06% ± 1.30% and Arms of 1.30%. COHb bias was 0.45 ± 1.63, with an Arms of 1.69% overall, and did not degrade substantially during moderate hypoxemia. MetHb bias was 0.36 ± 0.80 overall and stayed small with hypoxemia. Arms was 0.88 and was 10%. Pulse spectroscopy accurately detects hypoxemia, MetHb, and COHb. The technology also accurately detects these dysfunctional hemoglobins during hypoxemia. Future releases of this device may have an improved SpO2 algorithm that is more robust with methemoglobinemia.

Smoking: the influence of carboxyhemoglobin (HbCO) on tumor oxygenation and response to radiation

International Nuclear Information System (INIS)

Siemann, D.W.; Hill, R.P.; Bush, R.S.

1978-01-01

The effectiveness of localized x radiation on the transplantable KHT sarcoma was studied in nonanesthetized C3H mice possessing blood carboxyhemoglobin (HbCO) levels similar to those observed in heavy smokers. HbCO values of 10 percent were induced in tumor-bearing animals, either acutely just prior to irradiation or chronically during tumor growth and irradiation, by allowing the mice to breathe gas mixtures containing carbon monoxide (CO) in air. Tumors were irradiated either with single doses of 1500, 2000, or 2500 rad or with seven 500 rad fractions given at 24 hr intervals. Tumor cell survival was determined using an in vivo lung colony or an in vitro agar colony assay. The results with single doses of radiation indicate that under conditions of both acute and chronic exposure, the presence of 10 percent HbCO in the blood of the mice at the time of irradiation increases the survival of tumor cells in the hypoxic region of the survival curve by a factor of 2. During the fractionated irradiation, tumor cell survival in the presence of a 10 percent blood HbCO level (induced either acutely or chronically) was found to be significantly higher than that observed in air breathing mice. The results indicate that HbCO levels, such as are observed in heavy smokers, result in a larger fraction of hypoxic tumor cells. These findings suggest that heavy smoking prior to treatment may worsen the prognosis of patients undergoing radiotherapy

How valuable is P-wave dispersion in the determination of carboxyhemoglobin levels?

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Sener, M T; Anci, Y; Kalkan, K; Kir, M Z; Emet, M

2014-05-01

To determine whether or not wave/interval dispersions in electrocardiography (ECG) are increased, and to define whether wave and interval dispersions are correlated with carboxyhemoglobin (COHb) levels. ECG, complete blood count, and biochemical parameters were taken from 87 patients with carbon monoxide (CO) poisoning as well as 90 control patients with similar age, gender, and body mass index distribution. COHb levels were recorded in CO-poisoning patients. The COHb levels and the relationships with ECG parameters were studied. Pmax, Pmin, Pd, PRmax, PRmin, PRd, QTmax, QTmin, QTd, cQTmax, cQTmin, cQTd, Tmax, Tmin, and Td in ECG were higher in intoxicated patients than the control group (p < 0.05 for all). Pearson's correlation analyses showed moderately significant positive correlations between COHb level and Pmax (r = 0.224; p = 0.037) and Pd (r = 0.222; p = 0.039). The receiver-operator characteristic (ROC) curve showed that a Pd value of 38 ms determined by ECG separates patients with a COHb ≥ 20% with area under the ROC curve of 0.78 (95%CI = 0.71-0.83), a sensitivity of 67.9% (95%CI = 59.4-75.6), a specificity of 95% (95%CI = 83.0-99.2], a positive predictive value of 97.9% (95%CI = 92.5-99.7), and a negative predictive value of 46.3% (95%CI = 35.3-57.7.) A significant increase in wave/interval dispersions in the ECG of CO-poisoning patients compared with controls may show that not only a part is affected but both atrium and the ventricles as a whole are affected by hypoxic ischemia. When COHb levels of the patients are unavailable, P dispersion on ECG may show CO poisoning level of the patient.

Accuracy of carboxyhemoglobin detection by pulse CO-oximetry during hypoxemia.

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Feiner, John R; Rollins, Mark D; Sall, Jeffrey W; Eilers, Helge; Au, Paul; Bickler, Philip E

2013-10-01

Carbon monoxide poisoning is a significant problem in most countries, and a reliable method of quick diagnosis would greatly improve patient care. Until the recent introduction of a multiwavelength "pulse CO-oximeter" (Masimo Rainbow SET(®) Radical-7), obtaining carboxyhemoglobin (COHb) levels in blood required blood sampling and laboratory analysis. In this study, we sought to determine whether hypoxemia, which can accompany carbon monoxide poisoning, interferes with the accurate detection of COHb. Twelve healthy, nonsmoking, adult volunteers were fitted with 2 standard pulse-oximeter finger probes and 2 Rainbow probes for COHb detection. A radial arterial catheter was placed for blood sampling during 3 interventions: (1) increasing hypoxemia in incremental steps with arterial oxygen saturations (SaO2) of 100% to 80%; (2) normoxia with incremental increases in %COHb to 12%; and (3) elevated COHb combined with hypoxemia with SaO2 of 100% to 80%. Pulse-oximeter (SpCO) readings were compared with simultaneous arterial blood values at the various increments of hypoxemia and carboxyhemoglobinemia (≈25 samples per subject). Pulse CO-oximeter performance was analyzed by calculating the mean bias (SpCO - %COHb), standard deviation of the bias (precision), and the root-mean-square error (A(rms)). The Radical-7 accurately detected hypoxemia with both normal and elevated levels of COHb (bias mean ± SD: 0.44% ± 1.69% at %COHb <4%, and -0.29% ± 1.64% at %COHb ≥4%, P < 0.0001, and A(rms) 1.74% vs 1.67%). COHb was accurately detected during normoxia and moderate hypoxia (bias mean ± SD: -0.98 ± 2.6 at SaO2 ≥95%, and -0.7 ± 4.0 at SaO2 <95%, P = 0.60, and A(rms) 2.8% vs 4.0%), but when SaO2 decreased below approximately 85%, the pulse CO-oximeter always gave low signal quality errors and did not report SpCO values. In healthy volunteers, the Radical-7 pulse CO-oximeter accurately detects hypoxemia with both low and elevated COHb levels, and accurately detects COHb

[The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI)--a case report].

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Gałazkowski, Robert; Wejnarski, Arkadiusz; Baumberg, Ignacy; Świeżewski, Stanisław; Timler, Dariusz

2014-01-01

In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary.

Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia.

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Corbacioglu, Seref Kerem; Kilicaslan, Isa; Bildik, Fikret; Guleryuz, Atacan; Bekgoz, Burak; Ozel, Ayca; Keles, Ayfer; Demircan, Ahmet

2013-03-01

Previous studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP. Eighty-two patients with CAP were evaluated in this cross-sectional study during a 10-month period. Demographic data, pneumonia severity index and confusion, uremia, rate respiratory, pressure blood, age>65 (CURB-65) scores, hospital admission or discharge decisions, and 30-day hospital mortality rate were recorded. In addition, 83 control subjects were included to study. The COHb concentration was measured in arterial blood sample. The levels of COHb in patients with CAP were 1.70% (minimum-maximum, 0.8-3.2), whereas those in control subjects, 1.40% (minimum-maximum, 0.8-2.9). The higher COHb concentrations in patients with CAP were statistically significant (P < .05). Concentration of COHb correlated with pneumonia severity index (P = .04, r = 0.187); however, it did not correlate with CURB-65 (P = .218, r = 0.112). Although COHb concentrations show an increase in patients with pneumonia, it was concluded that this increase did not act as an indicator in diagnosis process or prediction of clinical severity for the physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

Carboxyhemoglobin half-life during hyperbaric oxygen in a patient with lung dysfunction: a case report.

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Weaver, Lindell K; Deru, Kayla

2017-01-01

The carboxyhemoglobin half-life (COHb t1/2) during hyperbaric oxygen (HBO₂) is often quoted as 23 minutes, derived from the average of two adult male volunteers breathing HBO₂ at 3 atmospheres absolute (ATA). However, the mean COHb t1/2 of 12 male volunteer smokers was 26.3 minutes at 1.58 ATA and in 12 non-intubated carbon monoxide (CO) poisoned patients treated at 3 ATA, was 43 minutes. An 81-year old male, poisoned by an improperly ventilated natural gas heater, was intubated for coma, then treated with HBO₂. His PaO₂/FiO₂ = 283 from aspiration. His initial COHb was 34.4%, and 18 minutes before HBO₂, 5.9%. After a compression interval of 17 minutes, the COHb measured after 22 minutes at 3 ATA was 3.3%. By exponential decay, his COHb t1/2 before HBO₂ was 95 minutes. We estimate the range for COHb t1/2 during compression as 62-81 minutes and for the 3-ATA interval, 58 to 49 minutes, respectively. The mid-point estimate of COHb t1/2 at 3 ATA was 53 minutes. The COHb t1/2 we calculated is greater than previously reported, but longer in our patient possibly because of concomitant respiratory failure, lung dysfunction, and mechanical ventilation. The often-cited COHb t1/2 of 23 minutes, likely underestimates the actual COHb t1/2 in CO-poisoned patients, especially those with cardiopulmonary dysfunction.

Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT(+) infants.

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Schutzman, D L; Gatien, E; Ajayi, S; Wong, R J

2016-05-01

To compare the degree of hemolysis in a group of direct antiglobulin test (DAT) positive (pos) African-American (AA) infants as measured by carboxyhemoglobin corrected (COHbc) for carbon monoxide in ambient air to a similar group of DAT negative (neg) ABO incompatible infants and a group without blood group incompatibility. To determine if COHbc is a better predictor of significant hyperbilirubinemia than DAT status. A prospective study of 180 AA infants from the Well-Baby Nursery of an inner city community hospital, all of whose mothers were type O pos. Infants (60) were ABO incompatible DAT pos, 60 were ABO incompatible DAT neg and 60 were type O(+). Blood for COHbc was drawn at the time of the infants' initial bilirubin and the infants' precise percentile on the Bhutani nomogram was calculated. Mean COHbc of type O(+) infants was 0.76±0.21 and 0.78±0.24% for ABO incompatible DAT neg infants (P=0.63). Mean CoHbc for the ABO incompatible DAT pos infants was 1.03±0.41% (P0.90% (area under the curve(AUC) 0.8113). This was similar to the AUC of the receiver operating characteristic curve using any titer strength of DAT pos as a cutoff (0.7960). Although not greatly superior to the titer strength of DAT pos, COHbc is useful in determining if the etiology of severe hyperbilirubinemia is a hemolytic process.

The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI – A case report

Directory of Open Access Journals (Sweden)

Robert Gałązkowski

2014-04-01

Full Text Available In 2013 a fire broke out in the Nursing Home (NH in the Henryszew village 5 km away from the district hospital in Żyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI. Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. Med Pr 2014;65(2:289–295

A new approach for the carbon monoxide (CO) exposure diagnosis: measurement of total CO in human blood versus carboxyhemoglobin (HbCO).

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Varlet, Vincent; De Croutte, Emma Lagroy; Augsburger, Marc; Mangin, Patrice

2013-07-01

The aim of the study is to present the application of a headspace-gas chromatography-mass spectrometry (HS-GC-MS) method for the determination of the carbon monoxide (CO) blood concentration and to compare it with carboxyhemoglobin (HbCO) saturation. In postmortem cases, the HbCO measured by spectrophotometry frequently leads to inaccurate results due to inadequate samples or analyses. The true role of CO intoxication in the death of a person could be misclassified. The estimation of HbCO from HS-GC-MS CO measurements provides helpful information by determining the total CO levels (CO linked to hemoglobin (HbCO) and CO dissociated from hemoglobin). The CO concentrations were converted in HbCO saturation levels to define cutoff blood CO values. CO limits were defined as less than 1 μmol/mL for living persons, less than 1.5 μmol/mL for dead persons without CO exposure, and greater than 3 μmol/mL for dead persons with clear CO poisoning. © 2013 American Academy of Forensic Sciences.

Pharmacologically increasing collateral perfusion during acute stroke using a carboxyhemoglobin gas transfer agent (Sanguinate™) in spontaneously hypertensive rats.

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Cipolla, Marilyn J; Linfante, Italo; Abuchowski, Abe; Jubin, Ronald; Chan, Siu-Lung

2018-05-01

Similar to patients with chronic hypertension, spontaneously hypertensive rats (SHR) develop fast core progression during middle cerebral artery occlusion (MCAO) resulting in large final infarct volumes. We investigated the effect of Sanguinate™ (SG), a PEGylated carboxyhemoglobin (COHb) gas transfer agent, on changes in collateral and reperfusion cerebral blood flow and brain injury in SHR during 2 h of MCAO. SG (8 mL/kg) or vehicle ( n = 6-8/group) was infused i.v. after 30 or 90 min of ischemia with 2 h reperfusion. Multi-site laser Doppler probes simultaneously measured changes in core MCA and collateral flow during ischemia and reperfusion using a validated method. Brain injury was measured using TTC. Animals were anesthetized with choral hydrate. Collateral flow changed little in vehicle-treated SHR during ischemia (-8 ± 9% vs. prior to infusion) whereas flow increased in SG-treated animals (29 ± 10%; p collateral flow in SHR during MCAO is consistent with small penumbra and large infarction. The ability to increase collateral flow in SHR with SG suggests that this compound may be useful as an adjunct to endovascular therapy and extend the time window for treatment.

[Case of interval form of carbon monoxide poisoning without increased carboxyhemoglobin level diagnosed by characteristic MR spectroscopy findings].

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Kamisawa, Tomoko; Ikawa, Masamichi; Hamano, Tadanori; Nagata, Miwako; Kimura, Hirohiko; Yoneda, Makoto

2014-01-01

A 67-year-old man living alone was admitted for acute disturbance of consciousness during winter. He presented with semicoma, a decorticate posture, and exaggerated tendon reflexes of the limbs, but brainstem reflexes were intact. The carboxyhemoglobin (COHb) level was normal in arterial blood gas on admission, and protein in cerebrospinal fluid was increased without pleocytosis. Brain MRI showed diffuse T2 high intensities in the deep white matter bilaterally without a contrast effect and abnormal T1 intensity in the pallidum. (1)H-MR spectroscopy (MRS) of the white matter lesion demonstrated findings suggesting demyelination as an increased choline peak, enhanced anaerobic metabolism as increased lactate and lipids peaks, and reduced neurons as a decreased N-acetylaspartate peak, which corresponded to delayed encephalopathy due to the interval form of carbon monoxide (CO) poisoning. The possibility of CO exposure due to coal briquette use 2 weeks before the symptomatic onset was indicated by his family, so he was diagnosed with CO poisoning. His consciousness slightly improved with corticosteroid therapy and repetitive hyperbaric oxygen therapy, but brain MRI and MRS findings did not improve. Characteristic MRS findings of leukoencephalopathy are helpful for diagnosing the interval form of CO poisoning in the case of a normal COHb level.

Using exhaled carbon monoxide and carboxyhemoglobin to evaluate the effectiveness of a chimney stove model in Peru.

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Eppler, Adam R; Fitzgerald, Christopher; Dorner, Stephen C; Aguilar-Villalobos, Manuel; Rathbun, Stephen L; Adetona, Olorunfemi; Naeher, Luke P

2013-01-01

Measurement of biological indicators of physiological change may be useful in evaluating the effectiveness of stove models, which are intended to reduce indoor smoke exposure and potential health effects. We examined changes in exhaled carbon monoxide (CO), percentage carboxy-hemoglobin, and total hemoglobin in response to the installation of a chimney stove model by the Juntos National Program in Huayatan, Peru in 2008. Biomarkers were measured in a convenience sample comprising 35 women who met requirements for participation, and were measured before and three weeks after installation of a chimney stove. The relationships between exposure to indoor smoke and biomarker measurements were also analyzed using simple linear regression models. Exhaled CO reduced from 6.71 ppm (95% CI 5.84-7.71) to 3.14 ppm (95% CI 2.77-3.66) three weeks after stove installation (P < 0.001) while % COHb reduced from 1.76% (95% CI 1.62-1.91) to 1.18% (95% CI 1.12-1.25; P < 0.001). Changes in exhaled CO and % COHb from pre- to post-chimney stove installation were not correlated with corresponding changes in exposure to CO and PM2.5 even though the exposures also reduced after stove installation. Exhaled CO and % COHb both showed improvement with reduction in concentration after the installation of the chimney cook stoves, indicating a positive physiological response subsequent to the intervention.

[Estimation of carbon monoxide poisonings frequency, based on carboxyhemoglobin determinations performed in Toxicology Laboratory in Krakow in years 2002-2010].

Science.gov (United States)

Gomółka, Ewa; Gawlikowski, Tomasz

2011-01-01

Carboxyhemoglobin is a specific biomarker of carbon monoxide (CO) exposition. The source of CO indoors are most often gas, oil or carbon furnaces and stoves or bathroom gas heaters. CO intoxication during fire or exposition to car fumes are sporadic. The aim of the study was: to present the frequency of CO intoxications diagnosed in Laboratory of Analytical Toxicology UJ Collegium Medicum in years 2002 - 2010, to present the season trends of CO intoxications, show sex and age structure of CO intoxicated patients. Material were Laboratory of Analytical Toxicology and Drug Monitoring data records from years 2002 - 2010. CO intoxication was confirmed and recognized when COHb blood concentration was higher than 10%. Annual number of CO poisonings was stable in the period of time, varied from 209 to 296 (mean 256,2 CO poisonings per year). Sex structure of CO poisoned patients showed little female dominance (54.6%). Carbon monoxide poisonings distribution was seasonal. The season of intensified CO intoxications lasted from October to March, the highest intensity was in December and January. The CO poisoning problem is still actual. Society education about security, recognition, diagnosis and practice in carbon monoxide exposition is still needful.

Carboxyhemoglobin levels in umbilical cord blood of women with pre-eclampsia and intrauterine growth restriction.

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Yusuf, Kamran; Kamaluddeen, Majeeda; Wilson, R Douglas; Akierman, Albert

2012-11-01

Pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are associated with abnormal placentation. Heme oxygenase (HO) and carbon monoxide (CO) are involved in normal placental development and function and vasomotor control in the placenta. The objective of our study was to measure CO levels, as assessed by carboxyhemoglobin (COHb) levels in the umbilical cord arterial blood of women with PE, normotensive IUGR (<10th percentile for birth weight), and normotensive pregnancies with appropriate-for-gestational age (AGA) infants. We prospectively analyzed COHb levels in the umbilical arterial blood of women with PE, normotensive IUGR, and normotensive AGA pregnancies. Exclusion criteria included cigarette smoke exposure, hemolytic disorders, a positive direct anti-globulin test, chronic hypertension, fever, and any significant medical illness. COHb levels were measured using the ABL 725 blood gas analyzer. There were 41 women in the normotensive AGA group, 42 in the PE group, and 36 in the normotensive IUGR group. Maternal age, mode of delivery, gravidity, parity, and gender of the infants were similar in the three groups. Gestational age and birth weight were significantly higher in the normotensive AGA group compared with the other two groups. COHb levels were significantly lower in the PE group compared with the normotensive AGA group (0.38±0.06% vs. 0.77±0.11%, P<0.05). COHb levels, although lower in the normotensive IUGR group compared with the normotensive AGA group, did not reach statistical significance. Our data suggests the HO-CO system may have a role in the pathogenesis of PE. We also, for the first time, provide information on umbilical arterial COHb levels in normotensive IUGR pregnancies.

Arterial Carboxyhemoglobin Measurement Is Useful for Evaluating Pulmonary Inflammation in Subjects with Interstitial Lung Disease.

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Hara, Yu; Shinkai, Masaharu; Kanoh, Soichiro; Fujikura, Yuji; K Rubin, Bruce; Kawana, Akihiko; Kaneko, Takeshi

2017-01-01

Objective The arterial concentration of carboxyhemoglobin (CO-Hb) in subjects with inflammatory pulmonary disease is higher than that in healthy individuals. We retrospectively analyzed the relationship between the CO-Hb concentration and established markers of disease severity in subjects with interstitial lung disease (ILD). Methods The CO-Hb concentration was measured in subjects with newly diagnosed or untreated ILD and the relationships between the CO-Hb concentration and the serum biomarker levels, lung function, high-resolution CT (HRCT) findings, and the uptake in gallium-67 ( 67 Ga) scintigraphy were evaluated. Results Eighty-one non-smoking subjects were studied (mean age, 67 years). Among these subjects, (A) 17 had stable idiopathic pulmonary fibrosis (IPF), (B) 9 had an acute exacerbation of IPF, (C) 44 had stable non-IPF, and (D) 11 had an exacerbation of non-IPF. The CO-Hb concentrations of these subjects were (A) 1.5±0.5%, (B) 2.1±0.5%, (C) 1.2±0.4%, and (D) 1.7±0.5%. The CO-Hb concentration was positively correlated with the serum levels of surfactant protein (SP)-A (r=0.38), SP-D (r=0.39), and the inflammation index (calculated from HRCT; r=0.57) and was negatively correlated with the partial pressure of oxygen in the arterial blood (r=-0.56) and the predicted diffusion capacity of carbon monoxide (r=-0.61). The CO-Hb concentrations in subjects with a negative heart sign on 67 Ga scintigraphy were higher than those in subjects without a negative heart sign (1.4±0.5% vs. 1.1±0.3%, p=0.018). Conclusion The CO-Hb levels of subjects with ILD were increased, particularly during an exacerbation, and were correlated with the parameters that reflect pulmonary inflammation.

The role of carboxyhemoglobin measured with CO-oximetry in the detection of hemolysis in newborns with ABO alloimmunization.

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Lozar-Krivec, Jana; Bratanic, Borut; Paro-Panjan, Darja

2016-01-01

To evaluate carboxyhemoglobin (COHb) values measured with a CO-oximeter (Roche-cobas b 221) in jaundiced newborns with or without hemolysis and healthy controls in order to assess whether COHb measurement determined with a CO-oximeter could be used as an indicator of hemolysis in newborns with ABO alloimmunization. A total of 86 term newborn infants were prospectively studied. The study cohort consisted of three subgroups: 18 infants with ABO HDN, 21 infants with hyperbilirubinemia without hemolytic disease who required phototherapy, and 47 healthy controls. The COHb, bilirubin, and Hb levels were measured. The three subgroups did not differ significantly with respect to birth weight, gestational age, gender, Apgar score, or mode of delivery. The ABO HDN infants had significantly higher COHb values than the healthy controls (median 2.4% versus 1.3%, p < 0.0005) and the group with hyperbilirubinemia without hemolytic disease (median 2.4% versus 1.3%, p < 0.0005), although the infants with hyperbilirubinemia without hemolytic disease did not have significantly higher COHb values compared with the healthy controls. The cut-off value of 1.7% COHb had 72% sensitivity and 97% specificity for confirming hemolysis in ABO alloimmunization. Our data show that COHb values determined with CO-oximeters are higher in newborns with hemolysis than in those without hemolysis. COHb measured with CO-oximeters could be used to confirm hemolysis in infants with ABO alloimmunization.

Lack of the correlation between biochemical effects on rats and blood carboxyhemoglobin concentrations in various conditions of single acute exposure to carbon monoxide

Energy Technology Data Exchange (ETDEWEB)

Sokal, J.A.

1975-01-01

The relationship between conditions of exposure to carbon monoxide (CO) and biochemical effects was investigated in experiments on rats. The magnitude and the time of biochemical disturbances in the tissues resulting from two different exposures consisting of 1 vol. percent CO for 4 min and 0.4 vol. percent CO for 40 min respectively were compared. In both cases, at the end of exposure the same level of blood carboxyhemoglobin (COHb) (about 50 percent) was reached. The biochemical determinations in the blood (pH, glucose, lactate, pyruvate) and brain tissue (lactate, pyruvate) were carried out immediately after termination of the exposure and after the time periods of restitution. CO exposure resulted in a decreased blood pH, increased level of blood glucose, as well as that of lactate and pyruvate both in blood and brain tissue. These changes were much more pronounced following the longer-lesser exposure than after the shorter-intense one, although blood concentrations of COHb was the same. The observed phenomenon puts some light on the frequently encountered lack of the correlation between COHb level in blood and severity of CO intoxication in clinical practice.

Use of hyperbaric oxygen therapy and PEGylated carboxyhemoglobin bovine in a Jehovah's Witness with life-threatening anemia following postpartum hemorrhage.

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Thenuwara, K; Thomas, J; Ibsen, M; Ituk, U; Choi, K; Nickel, E; Goodheart, M J

2017-02-01

We present a case of a Jehovah's Witness patient who refused blood products, with the exception of albumin and clotting factors, and underwent cesarean section under spinal anesthesia complicated by postpartum hemorrhage. She was fluid resuscitated and treated with multiple uterotonics and internal iliac artery embolization. Because of agitation she required emergency tracheal intubation. Her hemoglobin concentration dropped from a preoperative value of 12mg/dL to 3mg/dL on postoperative day one. She was acidotic, requiring vasopressors for hemodynamic stability and remained ventilated and sedated. She was treated with daily erythropoietin, iron therapy and cyanocobalamin. Because of ongoing hemorrhage, continued acidemia and vasopressor requirements she was co-treated with PEGylated carboxyhemoglobin bovine and hyperbaric oxygen therapy to reverse her oxygen debt. On postoperative day eight her hemoglobin concentration was 7mg/dL, she was hemodynamically stable and vasopressors were discontinued. She was extubated and discharged from the intensive care unit on postoperative day eight. This report highlights the multiple modalities used in treating a severely anemic patient who refused blood, the use of an investigational new drug, the process of obtaining this drug via the United States Food and Drug Administration emergency expanded access regulation for single patient clinical treatment, and ethical dilemmas faced during treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients.

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Koyuncu, Onur; Turhanoglu, Selim; Tuzcu, Kasım; Karcıoglu, Murat; Davarcı, Isil; Akbay, Ercan; Cevik, Cengiz; Ozer, Cahit; Sessler, Daniel I; Turan, Alparslan

2015-03-01

Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use. 100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups: COHb ≤3 or ≥4 g·dl(-1) . We considered a composite of complications during the 7 days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re-intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours. There were 36 patients in the low-exposure group COHb [1.8 ± 1.2 g·dl(-1) ], and 64 patients were in the high-exposure group [6.4 ± 2.1 g·dl(-1) ]. Indoor coal-burning stoves were reported more often by families of the high- than low-COHb children (89% vs 72%, P < 0.001). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb [47% vs 14%, P = 0.0001, OR:7.4 (95% Cl, lower = 2.5-upper = 21.7)], with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low-exposure group [respectively, P = 0.020 (95%CI, lower = -1.21-upper = -0.80), P = 0.026 (95% CI, lower = -0.03-upper = 0.70)], and tramadol use increased at 4 h (3.5 (interquartile range: 0-8) vs 6 (5-9) mg, P = 0.012) and

Admission Chest CT Complements Fiberoptic Bronchoscopy in Prediction of Adverse Outcomes in Thermally Injured Patients

Science.gov (United States)

2012-08-01

full-thickness burn (% FT), injury severity score (ISS), presence of tracheos- tomy, arterial carboxyhemoglobin levels (COHb), and the ratio (PFR) of...RADS, radiologist score; COHb, carboxyhemoglobin . Table 3. Results* Variable Inhalation Injury, N = 25 No Inhalation Injury, N = 19 P RADS 109 (74... carboxyhemoglobin . Table 6. Logistic regression predictor of composite outcome* Variable P Odds Ratio 95% Confidence Interval Limit I nhalation injury + RADS

Mathematical Modeling of Physical and Cognitive Performance Decrement from Mechanical and Inhalation Insults

Science.gov (United States)

2009-12-01

12  2.1.5  The effect of hypoxia and carboxyhemoglobin concentration on exercise performance in goats...B.L., Ng, L., and Stuhmiller, J.H. “The effects of hypoxia and carboxyhemoglobin concentration on a ‘phenomenological’ model’s recovery parameter...State. 2.1.5 The effect of hypoxia and carboxyhemoglobin concentration on exercise performance in goats The purpose of this study was to quantify if

Accuracy of noninvasive multiwave pulse oximetry compared with carboxyhemoglobin from blood gas analysis in unselected emergency department patients.

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Roth, Dominik; Herkner, Harald; Schreiber, Wolfgang; Hubmann, Nina; Gamper, Gunnar; Laggner, Anton N; Havel, Christof

2011-07-01

Accurate and timely diagnosis of carbon monoxide (CO) poisoning is difficult because of nonspecific symptoms. Multiwave pulse oximetry might facilitate the screening for occult poisoning by noninvasive measurement of carboxyhemoglobin (COHb), but its reliability is still unknown. We assess bias and precision of COHb oximetry compared with the criterion standard blood gas analysis. This was a prospective diagnostic accuracy study according to STARD (Standards for the Reporting of Diagnostic accuracy studies) criteria, performed at a tertiary care hospital emergency department. We included all patients for whom both invasive and noninvasive measurement within 60 minutes was available, regardless of their complaints, during a 1-year period. One thousand five hundred seventy-eight subjects were studied, of whom 17 (1.1%) received a diagnosis of CO poisoning. In accordance with this limited patient cohort, we found a bias of 2.99% COHb (1.50% for smokers, 4.33% for nonsmokers) and a precision of 3.27% COHb (2.90% for smokers, 2.98% for nonsmokers), limits of agreement from -3.55% to 9.53% COHb (-4.30% to 7.30% for smokers, -1.63% to 10.29% for nonsmokers). Upper limit of normal cutoff of 6.6% COHb had the highest sensitivity in screening for CO poisoning. Smoking status and COHb level had the most influence on the deviation between measurements. Multiwave pulse oximetry was found to measure COHb with an acceptable bias and precision. These results suggest it can be used to screen large numbers of patients for occult CO poisoning. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Assessment of carboxyhemoglobin, hydrogen cyanide and methemoglobin in fire victims: a novel approach.

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Ferrari, Luis A; Giannuzzi, Leda

2015-11-01

To establish the cause of death, carboxyhemoglobin (COHb), total hemoglobin (tHb), methemoglobin (MetHb), and hydrogen cyanide (HCN) were quantified in the blood of fire victims. We analyzed 32 out of 33 blood samples from forensic autopsy cases in a disastrous polyurethane mattress fire, which caused the deaths of 33 inmates at a prison in Argentina in 2006. The cadaveric blood samples were collected by femoral vein puncture. These samples were analyzed using the IL80 CO-oximeter system for tHb, MetHb, and COHb levels and by microdiffusion for HCN and COHb levels. Blood alcohol (ethanol) and drugs were examined by headspace gas chromatography-flame ionization detection (HS-GC-FID) and GC-mass spectrometry (MS), respectively. Polyurethane mattress samples were analyzed according to the California 117 protocol. The saturation of COHb ranged from 10% to 43%, tHb from 2% to 19.7%, MetHb from 0.10% to 35.7%, and HCN from 0.24 to 15mg/L. These HCN values are higher than the lethal levels reported in the literature. Other toxic components routinely measured (ethanol, methanol, aldehydes, and other volatile compounds) gave negative results in the 32 cases. Neither drugs of abuse nor psychotropic drugs were detected. The results indicate that death in the 32 fire victims was probably caused in part by HCN, generated during the extensive polyurethane decomposition stimulated by a rapid increase in temperature. We also considered the influence of oxygen depletion and the formation of other volatile compounds such as NOx in this disaster, as well as pathological evidence demonstrating that heat was not the cause of death in all victims. Furthermore, statistical analysis showed that the percentage values of COHb and MetHb in the blood were not independent variables, with χ(2)=11.12 (theoretical χ(2)=4.09, degrees of freedom=12, and α=0.05). However, no correlation was found between HCN and MetHb in the blood of the victims. This is the first report to assess the

Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner.

Directory of Open Access Journals (Sweden)

Margot P Bickler

Full Text Available Detecting life-threatening common dyshemoglobins such as carboxyhemoglobin (COHb, resulting from carbon monoxide poisoning or methemoglobin (MetHb, caused by exposure to nitrates typically requires a laboratory CO-oximeter. Because of cost, these spectrophotometer-based instrument are often inaccessible in resource-poor settings. The aim of this study was to determine if an inexpensive pocket infrared spectrometer and smartphone (SCiO®Pocket Molecular Sensor, Consumer Physics Ltd., Israel accurately detects COHb and MetHb in single drops of blood. COHb was created by adding carbon monoxide gas to syringes of heparinized blood human or cow blood. In separate syringes, MetHb was produced by addition of sodium nitrite solution. After incubation and mixing, fractional concentrations of COHb or MetHb were measured using a Radiometer ABL-90 Flex® CO-oximeter. Fifty microliters of the sample were then placed on a microscope slide, a cover slip applied and scanned with the SCiO spectrometer. The spectrograms were used to create simple linear models predicting [COHb] or [MetHb] based on spectrogram maxima, minima and isobestic wavelengths. Our model predicted clinically significant carbon monoxide poisoning (COHb ≥15% with a sensitivity of 93% and specificity of 88% (regression r2 = 0.63, slope P20% MetHb was detected with a sensitivity of 100% and specificity of 71% (regression r2 = 0.92, slope P15% COHb or >20% MetHb on a single drop of blood with enough accuracy to be useful as an initial clinical screening. The SCiO and similar relatively low cost spectrometers could be developed as inexpensive diagnostic tools for developing countries.

Accuracy of detection of carboxyhemoglobin and methemoglobin in human and bovine blood with an inexpensive, pocket-size infrared scanner.

Science.gov (United States)

Bickler, Margot P; Rhodes, Laura J

2018-01-01

Detecting life-threatening common dyshemoglobins such as carboxyhemoglobin (COHb, resulting from carbon monoxide poisoning) or methemoglobin (MetHb, caused by exposure to nitrates) typically requires a laboratory CO-oximeter. Because of cost, these spectrophotometer-based instrument are often inaccessible in resource-poor settings. The aim of this study was to determine if an inexpensive pocket infrared spectrometer and smartphone (SCiO®Pocket Molecular Sensor, Consumer Physics Ltd., Israel) accurately detects COHb and MetHb in single drops of blood. COHb was created by adding carbon monoxide gas to syringes of heparinized blood human or cow blood. In separate syringes, MetHb was produced by addition of sodium nitrite solution. After incubation and mixing, fractional concentrations of COHb or MetHb were measured using a Radiometer ABL-90 Flex® CO-oximeter. Fifty microliters of the sample were then placed on a microscope slide, a cover slip applied and scanned with the SCiO spectrometer. The spectrograms were used to create simple linear models predicting [COHb] or [MetHb] based on spectrogram maxima, minima and isobestic wavelengths. Our model predicted clinically significant carbon monoxide poisoning (COHb ≥15%) with a sensitivity of 93% and specificity of 88% (regression r2 = 0.63, slope P20% MetHb) was detected with a sensitivity of 100% and specificity of 71% (regression r2 = 0.92, slope Psmartphone detects >15% COHb or >20% MetHb on a single drop of blood with enough accuracy to be useful as an initial clinical screening. The SCiO and similar relatively low cost spectrometers could be developed as inexpensive diagnostic tools for developing countries.

Carbon Monoxide Exposure in Youth Ice Hockey.

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Macnow, Theodore; Mannix, Rebekah; Meehan, William P

2017-11-01

To examine the effect of ice resurfacer type on carboxyhemoglobin levels in youth hockey players. We hypothesized that players in arenas with electric resurfacers would have normal, stable carboxyhemoglobin levels during games, whereas those in arenas with internal combustion engine (IC) resurfacers would have an increase in carboxyhemoglobin levels. Prospective cohort study. Enclosed ice arenas in the northeastern United States. Convenience sample of players aged 8 to 18 years old in 16 games at different arenas. Eight arenas (37 players) used an IC ice resurfacer and 8 arenas (36 players) an electric resurfacer. Carboxyhemoglobin levels (SpCO) were measured using a pulse CO-oximeter before and after the game. Arena air was tested for carbon monoxide (CO) using a metered gas detector. Players completed symptom questionnaires. The change in SpCO from pregame to postgame was compared between players at arenas with electric versus IC resurfacers. Carbon monoxide was present at 6 of 8 arenas using IC resurfacers, levels ranged from 4 to 42 parts per million. Carbon monoxide was not found at arenas with electric resurfacers. Players at arenas with IC resurfacers had higher median pregame SpCO levels compared with those at electric arenas (4.3% vs 1%, P carboxyhemoglobin during games and have elevated baseline carboxyhemoglobin levels compared with players at arenas with electric resurfacers. Electric resurfacers decrease the risk of CO exposure.

Valores de referência para carboxiemoglobina Reference values for carboxyhemoglobin

Directory of Open Access Journals (Sweden)

Maria Elisa P. B. de Siqueira

1997-12-01

the present study, the RV for carboxyhemoglobin (COHb was determined for the South of Minas Gerais. MATERIAL AND METHOD: The COHb was analyzed by the Beutler and West (1984 spectrophotometric method, optimized in our laboratory. In all the samples, analyses of some biochemical and hematological parameters were made to evaluate the health condition of a population of 200 volunteer non-smokers occupationally not exposed to CO. Each individual answered a questionnaire to obtain data pertinent to the interpretation of the results. The reference values were expressed as mean values ± standard deviation, with a 95% confidence interval, and an upper reference value. The statistical distribution of the results was made so as to enable comparisons between the results of groups of workers, rather than individual evaluations, to be made. RESULTS AND CONCLUSION: The mean value ± standard deviation was 1.0% ± 0.75; the 95% confidence interval was 0,9 - 1.1% and the upper reference value was 2.5%. By the t Student test (p < 0.05, no difference was detected between the values related to sex, age or ingestion of alcoholic beverages. The reference values obtained were close to those reported for others countries.

In Vitro Absorption of Atmospheric Carbon Monoxide and Hydrogen Cyanide in Undisturbed Pooled Blood

Science.gov (United States)

2012-09-01

are analyzed for carboxyhemoglobin (COHb) and cyanide ion (CN¯) in blood. Such victims quite often suffer large open wounds near the autopsy blood...could.lead.investigators.to.erroneously.conclude.that.the. presence.of. carboxyhemoglobin . (COHb).and.cyanide. ion.(CN

Detection of carboxyhemoglobin in patients with hepatic encephalopathy due to hepatitis B virus-related cirrhosis.

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Sun, Xiao-yu; Duan, Zhi-jun; Li, Yan-lian; Chang, Qing-shan

2012-11-01

The heme oxygenase/carbon monoxide (HO/CO) system plays an important role in the development of hepatic fibrosis. The level of the HO/CO can be directly obtained by determining the carboxyhemoglobin (COHb) level. The aims of this study were to reveal the significance of COHb in patients with hepatitis B virus-related cirrhosis (HBC) complicated by hepatic encephalopathy (HE), and to further investigate the influence of the HO/CO pathway on the end-stage cirrhosis, hoping to find a reliable indicator to evaluate the course of HBC. According to the diagnostic criteria, 63 HBC inpatients with HE were enrolled in group H. Patients regaining awareness with current therapies were categorized into group P-H. Comparisons were made with a control group (group N) consisting of 20 health volunteers. The levels of COHb, partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) were determined by arterial blood gas analysis method. The incidences of hepatorenal syndrome (HRS), upper gastrointestinal bleeding, esophagogastric varices and spontaneous bacterial peritonitis (SBP) in group H were recorded. COHb levels in different groups were compared, and the correlations of COHb levels with HE grades (I, II, III, and IV), PaO2, SaO2 and hypoxemia were analyzed. The COHb level in group P-H ((1.672 ± 0.761)%) was significantly higher than that in group N ((0.983 ± 0.231)%) (P 0.05) or the occurrence of SBP ((2.960 ± 0.561)% vs. (2.030 ± 1.021)%, P > 0.05). Compared with HE patients with HRS, the level of COHb was significantly higher in HE patients without HRS ((2.502 ± 1.073)% vs. (1.981 ± 1.020)%, P = 0.029). The COHb level had a negative correlation with PaO2 (r = -0.335, P = 0.007) while no statistically significant relationship was found with SaO2 (r = -0.071, P > 0.05). However, when the above two parameters met the diagnostic criteria of hypoxemia, the COHb concentration increased ((2.621 ± 0.880)% vs. (1.910 ± 0.931)%, P = 0.011). COHb is a potential candidate

Airway Management and Smoke Inhalation Injury in the Burn Patient

Science.gov (United States)

2009-10-01

see the previous discussion in this article), patient history and physical examination, and carboxyhemoglobin levels (if available) are used. The...addition to combining with hemoglobin to form carboxyhemoglobin (COHb), where in the CO has an affinity for hemo- globin which is 200 times that of

Investigation of oxyhemoglobin and carboxyhemoglobin ratios in right and left cardiac blood for diagnosis of fatal hypothermia and death by fire.

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Kanto-Nishimaki, Yuko; Saito, Haruka; Watanabe-Aoyagi, Miwako; Toda, Ritsuko; Iwadate, Kimiharu

2014-11-01

Few large-scale investigations have looked at the oxyhemoglobin ratio (%O2-Hb) or the carboxyhemoglobin ratio (%CO-Hb) in fatal hypothermia and death by fire as applicable to forensic medicine. We therefore retrospectively examined right and left cardiac blood samples for both %O2-Hb and %CO-Hb in 690 forensic autopsy cases. We therefore sought to establish reference values for the above forensic diagnoses, to compare %O2-Hb in fatal hypothermia with or without cardiopulmonary resuscitation (CPR), and to compare the relationship between %CO-Hb and smoking history. All %O2-Hb and %CO-Hb data were obtained during or immediately after autopsies using a portable CO-oximeter. Death by carbon monoxide (CO) intoxication and death by fire were excluded from the analysis involving smoking history. In fatal hypothermia, %O2-Hb in the left cardiac blood was significantly higher than that in the right cardiac blood, providing important evidence for fatal hypothermia. Furthermore, %O2-Hb in the left cardiac blood increases with CPR but that in the right cardiac blood increases in parallel. No correlation was observed between rectal temperature and %O2-Hb in the right and left cardiac blood, indicating that it is unlikely that postmortem cooling increases %O2-Hb in cardiac blood. %CO-Hb in smokers was significantly higher than that in non-smokers, although the number of cigarettes smoked did not appear to be significant. When assessing death by fire, we identified that %CO-Hb of >10% was a reliable marker of antemortem CO inhalation, regardless of smoking history. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Carbon monoxide, smoking, and atherosclerosis

Energy Technology Data Exchange (ETDEWEB)

Astrup, P

1973-10-01

Studies on the effects of carbon monoxide and smoking on atherosclerosis are reviewed. Nonsmokers do not run the risk of getting significantly elevated carboxyhemoglobin levels from automobile exhaust in the streets, however, they do run the risk of getting elevated carboxyhemoglobin levels from exposure to CO in closed areas such as garages and tunnels. Carboxyhemoglobin levels up to 20 percent may also be found in smokers. The central nervous system seems to be influenced by carboxyhemoglobin concentrations up to 20 percent. The myocardium may also be affected. Experimental work with rabbits exposed to carbon monoxide and cholesterol is described which proved that CO has a damaging effect on arterial walls, leading to increased permeability for various plasma components, to the formation of subendothelial edema, and to increased atheromatosis. The results indicate that the much higher risk of smokers of developing arterial disease in comparison to nonsmokers is mainly due to the inhaled CO in the tobacco smoke and not to nicotine. (Air Pollut. Abstr.)

Application of DNA Profiling in Resolving Aviation Forensic Toxicology Issues

Science.gov (United States)

2009-10-01

muscle,.spleen,.and.vitreous.fluid Toxicological Findings Pilot: Carboxyhemoglobin .20% Cyanide.1 .80.µg/mL.in.blood Diphenhydramine.0 .030.µg/mL.in.blood...Diphenhydramine.present.in.liver Copilot: Carboxyhemoglobin .25% Cyanide.2 .07.µg/mL.in.blood Diphenhydramine.0 .036.µg/mL.in.blood

Effect of smoking on oxygen delivery and outcome in patients treated with radiotherapy for head and neck squamous cell carcinoma – A prospective study

International Nuclear Information System (INIS)

Molich Hoff, Camilla; Grau, Cai; Overgaard, Jens

2012-01-01

Background: Head and neck cancer patients with high hemoglobin respond better to irradiation compared to patients with low hemoglobin possibly due to hypoxia induced radioresistance. The hemoglobin level is, however, a crude indicator of the amount of oxygen available to the tissue and may be influenced by a number of factors, smoking being of potential importance. The aim of the present study was to examine the effect of smoking on available oxygen to tumors and the effect on outcome in head and neck cancer patients treated with radiotherapy in a prospective study. Materials and methods: A total of 232 consecutive patients with squamous cell carcinoma of the larynx, pharynx and oral cavity completed questionnaires on smoking habits prior to treatment. Venous blood samples were collected before and/or during treatment to determine the hemoglobin and carboxyhemoglobin level. Patients were treated with primary curative radiotherapy 62–68 Gy, 2 Gy/fx, 5 fx/week. Results: All but 12 patients had a history of smoking, 35 were long term quitters, 23 recent quitters, 54 moderate smokers and 108 heavy smokers (>1 pack/day). There was no relationship between total hemoglobin and carboxyhemoglobin, but effective hemoglobin and carboxyhemoglobin were linearly correlated. The amount of carboxyhemoglobin increased with increasing smoking status. Actuarial 5-year univariate analysis showed that heavy smokers had a significantly reduced probability of loco-regional control (44% vs. 65%, p = 0.001), disease-specific (56% vs. 77%, p = 0.003) and overall survival (39% vs. 66%, p = 0.0004) compared to non-smoking patients. Multivariate analyses showed that patients characterized as non-smokers, with low T and N classifications and high hemoglobin level had the best outcome measurements. A rise in carboxyhemoglobin significantly decreased the probability of loco-regional control and each additional pack year increased the risk of death. Smokers and former smokers develop secondary

Review of autopsy reports of deaths relating to fire in South Australia 2000-2015.

Science.gov (United States)

Sully, Claire J; Walker, G Stewart; Langlois, Neil E I

2018-06-01

It has been noted there are gaps and inconsistencies in data pertaining to fire related deaths in Australia, which poses difficulties for analysis of national statistics. A search of post-mortem examination reports at Forensic Science SA from 2000 to 2015 revealed 275 cases regarded as fire related in which the body had been involved in a fire. The autopsy reports were evaluated to determine parameters including the location of the fire event, age and sex of victim, as well as the presence of soot in the airways and cherry-red coloration to the blood and/or organs, in addtion to toxicological levels of carboxyhemoglobin and alcohol. Fire events were clasified as structural, transportation or open air in type. Males were more commonly victims than females, especially in transportation fires, where males aged below 50 years were most at risk of death. Carboxyhemoglobin levels tended to be lower in victims of transportation fires. This study has confirmed that presence of soot in the respiratory tract and cherry-red coloration of a body retrieved from a fire are both linked to an increased level of blood carboxyhemoglobin. These findings significantly contribute to the documentation of fire deaths in Australia.

Serum bilirubin value predicts hospital admission in carbon monoxide-poisoned patients. Active player or simple bystander?

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Gianfranco Cervellin

Full Text Available OBJECTIVES: Although carbon monoxide poisoning is a major medical emergency, the armamentarium of recognized prognostic biomarkers displays unsatisfactory diagnostic performance for predicting cumulative endpoints. METHODS: We performed a retrospective and observational study to identify all patients admitted for carbon monoxide poisoning during a 2-year period. Complete demographical and clinical information, along with the laboratory data regarding arterial carboxyhemoglobin, hemoglobin, blood lactate and total serum bilirubin, was retrieved. RESULTS: The study population consisted of 38 poisoned patients (23 females and 15 males; mean age 39±21 years. Compared with discharged subjects, hospitalized patients displayed significantly higher values for blood lactate and total serum bilirubin, whereas arterial carboxyhemoglobin and hemoglobin did not differ. In a univariate analysis, hospitalization was significantly associated with blood lactate and total serum bilirubin, but not with age, sex, hemoglobin or carboxyhemoglobin. The diagnostic performance obtained after combining the blood lactate and total serum bilirubin results (area under the curve, 0.90; 95% CI, 0.81-0.99; p<0.001 was better than that obtained for either parameter alone. CONCLUSION: Although it remains unclear whether total serum bilirubin acts as an active player or a bystander, we conclude that the systematic assessment of bilirubin may, alongside lactate levels, provide useful information for clinical decision making regarding carbon monoxide poisoning.

A Retrospective Analysis of Pediatric Patients Admitted to the Pediatric Emergency Service for Carbon Monoxide Intoxication

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Metin Uysalol

2011-09-01

Full Text Available Objective: The aim of the study is to analyze the general aspects of cases with carbon monoxide intoxication in order to improve the approach to future patients. Material and Methods: The hospital records of 84 children (mean age 4.71±2.64 years; 48 male, 36 female who had been admitted to Paediatric Emergency Department for carbon monoxide intoxication between October 2007 and February 2009, were retrospectively evaluated in a descriptive analysis.Results: The source of carbon monoxide intoxication was heaters, waterheaters and fi re in 82.1%, 7.1% and 6% of cases, respectively. There was a statistically signifi cant difference between the carboxyhemoglobin levels of the patients according to the clinical classifi cation (p<0.05. The intoxication caused by heaters was observed signifi cantly in November, December and January (p<0.001, between 16:00-24:00 hours (p<0.001 and among more than one member of a family (p<0.001. A medium level correlation was detected between the treatment approach and clinical classifi cation (r=0.50, p<0.001. Conclusion: Carbon monoxide intoxication, in the presented series, was found to develop accidentally; mostly in the Winter season; during night hours when the family members gathered together. The carboxyhemoglobin levels were appropriate with the developing clinical findings. Carboxyhemoglobin level solely was not enough for achieving the diagnosis and planning the treatment.

In Vitro Absorption of Atmospheric Carbon Monoxide and Hydrogen Cyanide in Undisturbed Pooled Blood

Science.gov (United States)

2012-09-01

Biological samples from victims of aircraft accidents are analyzed for carboxyhemoglobin (COHb) and cyanide ion : (CN) in blood. Such victims quite often suffer large open wounds near the autopsy blood collection sites. Many : aircraft crashes resu...

Lyophilized bovine hemoglobin as a possible reference material for the determination of hemoglobin derivatives in human blood

NARCIS (Netherlands)

Maas, BHA; Buursma, A; Ernst, RAJ; Maas, AHJ; Zijlstra, WG

We investigated the suitability of a lyophilized bovine hemoglobin (LBH) preparation containing various fractions of oxyhemoglobin (O(2)Hb), carboxyhemoglobin (COHb), and methemoglobin (MetHb) for quality assessment in multicomponent analysis (MCA) of hemoglobin derivatives. It was demonstrated that

Lyophilized bovine hemoglobin as a possible reference material for the determination of hemoglobin derivatives in human blood

NARCIS (Netherlands)

Maas, BHA; Buursma, A; Ernst, RAJ; Maas, AHJ; Zijlstra, WG

1998-01-01

We investigated the suitability of a lyophilized bovine hemoglobin (LBH) preparation containing various fractions of oxyhemoglobin (O(2)Hb), carboxyhemoglobin (COHb), and methemoglobin (MetHb) for quality assessment in multicomponent analysis (MCA) of hemoglobin derivatives. It was demonstrated that

Structural Findings in the Brain MRI of Patients with Acute Carbon Monoxide Poisoning

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Yasmin Davoudi

2014-09-01

Conclusion: The white matter and globus pallidus were the most common affected regions in brain following acute CO poisoning. Signal abnormalities and restricted diffusion in MRI were correlated with duration of exposure to CO but not with the carboxyhemoglobin levels.

CARBON MONOXIDE AND THE NERVOUS SYSTEM

Science.gov (United States)

Carbon monoxide (CO) is a colorless, tasteless, odorless, and non-irritating gas formed when carbon in fuel is not burned completely. It enters the bloodstream through the lungs and attaches to hemoglobin (Hb), the body's oxygen carrier, forming carboxyhemoglobin (COHb) and there...

CARBON MONOOXIDE AND THE NERVOUS SYSTEM

Science.gov (United States)

Carbon monoxide (CO) is a colorless, tasteless, odorless, and non-irriating gas formed when carbon fuel is not burned completely. It enter the bloodstream through the lungs and attaches to hemoglobin (Hb), the body's oxygen carrier, forming carboxyhemoglobin (COHb) and thereby r...

Serum heavy metals and hemoglobin related compounds in Saudi Arabia firefighters

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Al-Malki Abdulrahman L

2009-07-01

Full Text Available Abstract Background Firefighters are frequently exposed to significant concentrations of hazardous materials including heavy metals, aldehydes, hydrogen chloride, dichlorofluoromethane and some particulates. Many of these materials have been implicated in the triggering of several diseases. The aim of the present study is to investigate the effect of fire smoke exposure on serum heavy metals and possible affection on iron functions compounds (total iron binding capacity, transferrin saturation percent, ferritin, unsaturated iron-binding capacity blood hemoglobin and carboxyhemoglobin,. Subjects and methods Two groups of male firefighter volunteers were included; the first included 28 firefighters from Jeddah city, while the second included 21 firefighters from Yanbu city with an overall age rang of 20–48 years. An additional group of 23 male non-firefighters volunteered from both cities as normal control subjects. Blood samples were collected from all volunteer subjects and investigated for relevant parameters. Results The results obtained showed that there were no statistically significant changes in the levels of serum heavy metals in firefighters as compared to normal control subjects. Blood carboxyhemoglobin and serum ferritin were statistically increased in Jeddah firefighters, (p Conclusion Such results might point to the need for more health protective and prophylactic measures to avoid such hazardous health effects (elevated Blood carboxyhemoglobin and serum ferritin and decreased serum TIBC and UIBC that might endanger firefighters working under dangerous conditions. Firefighters must be under regular medical follow-up through standard timetabled medical laboratory investigations to allow for early detection of any serum biochemical or blood hematological changes.

Simulations of exercise and brain effects of acute exposure to carbon monoxide in normal and vascular-diseased persons.

Science.gov (United States)

At some level, carboxyhemoglobin (RbCO) due to inhalation of carbon monoxide (CO) reduces maximum exercise duration in normal and ischemic heart patients. At high RbCO levels in normal subjects, brain function is also affected and behavioral performance is impaired. These are fin...

Heme oxygenase activity increases after exercise in healthy volunteers

Science.gov (United States)

AbstractHeme oxygenase (HO) is an essential, rate-limiting protein which participates in the catabolism of heme to iron, carbon monoxide (CO), and biliverdin. The alpha methene bridge carbon of the heme is eliminated as CO which can be measured as blood carboxyhemoglobin (COHb)....

Carbon monoxide inhalation induces headache in a human headache model

DEFF Research Database (Denmark)

Arngrim, Nanna; Schytz, Henrik Winther; Britze, Josefine

2018-01-01

, double-blind, placebo-controlled crossover design, 12 healthy volunteers were allocated to inhalation of CO (carboxyhemoglobin 22%) or placebo on two separate days. Headache was scored on a verbal rating scale from 0-10. We recorded mean blood velocity in the middle cerebral artery (VMCA) by transcranial...

A mathematical modeling approach to risk assessment for normal and anemic women chronically exposed to carbon monoxide from biomass-fueled cookstoves

Science.gov (United States)

Bruce, Margaret C.; Erupaka-Chada, Kinnera

2011-01-01

In developing countries, the chronic exposure to carbon monoxide (CO) from biomass-fueled cookstoves may pose a significant health risk for women who use these stoves, especially for those with underlying clinical conditions that impair tissue oxygenation, e.g., anemia and coronary artery disease. CO concentrations measured in the vicinity of these cookstoves often exceed World Health Organization (WHO) indoor air guidelines for an 8-h average (9 ppm) and a 1-h maximum (26 ppm). Carboxyhemoglobin levels, reported infrequently because they are difficult to obtain, often exceed the WHO threshold of 2.5%. Despite this evidence, specific adverse effects have not yet been linked with chronic CO exposures in these women. Furthermore, anemia, which is prevalent in populations that use biomass fuels, could exacerbate the adverse effects of chronic CO exposure. Because of the difficulties inherent in conducting prospective studies to address this issue, we used a mathematical model to calculate the effects of reported CO levels and exercise on carboxyhemoglobin for women living in 1) Guatemalan villages at altitudes of 4,429–4,593 ft, and 2) coastal villages in Pakistan. In addition, we used the model to calculate the effects of CO exposures in women with moderate to severe anemia on specific physiological parameters (carboxyhemoglobin, carboxymyoglobin, cardiac output, and tissue Po2) at exercise levels representing the activities in which these women would be engaged. Our results demonstrate the efficacy of using a mathematical model to predict the physiologic responses to CO and also demonstrate that chronic anemia is a critically important determinant of CO toxicity in these women. PMID:21596914

Evaluation of carbon monoxide in blood samples from the second health and nutrition survey. Progress report No. 1

Energy Technology Data Exchange (ETDEWEB)

Radford, E.P.

1976-01-01

This is a study of carbon monoxide (CO) in the blood of human subjects participating in the Second National Health and Nutrition Survey (HANES II), a detailed study of health indicators in sample populations of many communities throughout the U.S. The purpose of this aspect of the survey is to evaluate the levels of blood carboxyhemoglobin in normal individuals of all ages in typical U.S. communities, from whom accurate histories and clinical studies are available. This report gives results of the first of three years of analyses. A careful calibration of the analytical method has been completed, and more than 3000 blood samples have been analyzed. Although smoking histories are not yet available to permit evaluation of carboxyhemoglobin in non-smokers, in children under 12 years of age, blood COHb has been found to be consistently low, with less than 3% greater than 1.5% COHb. These preliminary results suggest that urban exposure to carbon monoxide among the general population is not now significant in the U.S., at least during the period of these early examinations.

PATHO-PHYSIOLOGICAL MECHANISMS OF TOBACCO SMOKING EFFECT ON THE CARDIOVASCULAR SYSTEM

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V.F. Kirichuk

2007-09-01

Full Text Available Modern patho-physiological mechanisms with the help of which tobacco smoking contributes to the development of cardiovascular pathology are represented in the review. The most significant of them are endothelial dysfunction, progressing of atherosclerotic processes, alteration of rheologic properties of blood, increase of carboxyhemoglobin levels, activation of sympathetic nervous system of the heart.

Carbon monoxide and coronary heart disease

Energy Technology Data Exchange (ETDEWEB)

Scheidemandel, V

1974-01-01

Studies on the relationship between increased carboxyhemoglobin levels in the blood and coronary heart disease in smokers and city dwellers are reviewed. The evidence of myocardial infarction is significantly higher in smokers than in nonsmokers which is due, apart from nicotine which promotes coronary arteriosclerosis, to inhaled carbon monoxide which leads to increased carboxyhemoglobin levels and most likely plays a role in the risk of arteriosclerosis and the coronary heart disease. Apart from combining with hemoglobin, CO increases the circulation rate and the coronary blood flow, and reduces the coronary arteriovenous oxygen difference, which is indicative of a reduced rate of oxygen extraction by the myocardium against an increased myocardial oxygen demand. The reduction of the oxygen extraction correlates with the increased COHb level. Inhaled CO lowers the threshold of angina pectoris due to the reduced myocardial oxygen tension. Also, considerable reduction of the oxygen diffusion from the capillaries toward the mitochondria due to the combination of CO with myoglobin is observed. Chronically increased CO levels in the blood and tissues not only accelerate the development of arteriosclerosis, but also induce a process directly injurious to the myocardial metabolism. (Air Pollut. Abstr.)

Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial.

Science.gov (United States)

Ocak, Tarik; Tekin, Erdal; Basturk, Mustafa; Duran, Arif; Serinken, Mustafa; Emet, Mucahit

2016-11-01

There is a lack of specificity of the analgesic agents used to treat headache and underlying acute carbon monoxide poisoning. To compare effectiveness of "oxygen alone" vs "metoclopramide plus oxygen" vs "metamizole plus oxygen" therapy in treating carbon monoxide-induced headache. A prospective, multicenter, double-blind, controlled trial. Three emergency departments in Turkey. Adult carbon monoxide poisoning patients with headache. A total of 117 carbon monoxide-intoxicated patients with headache were randomized into 3 groups and assessed at baseline, 30 minutes, 90 minutes, and 4 hours. The primary outcome was patient-reported improvement rates for headache. Secondary end points included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels. During observation, there was no statistical difference between drug type and visual analog scale score change at 30 minutes, 90 minutes, or 4 hours, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the 3 groups. The use of "oxygen alone" is as efficacious as "oxygen plus metoclopramide" or "oxygen plus metamizole sodium" in the treatment of carbon monoxide-induced headache. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation air quality during a motocross competition in the Val d'Or arena; Evaluation de la qualite de l'air lors d'une competition de motocross a l'arena de Val d'Or

Energy Technology Data Exchange (ETDEWEB)

Gagne, D. [Regional Board of Health and Social Services, Abitibi-Temiscamingue, PQ, (Canada)

1999-07-01

A motocross competition took place in the Val d'Or arena on June 29, 1999, attended by several hundred spectators. The Directorate of Public Health and other relevant authorities jointly established a limit on permissible carbon monoxide concentration inside the facility to prevent the over exposure of those present. Organizers of the competition ignored the pre-set limit causing carboxyhemoglobin concentration to rise to about five per cent among those spectators who attended the majority of the events. Several hours were required for the carboxyhemoglobin concentration to return to normal levels (below three per cent). An investigation was conducted following the event which established that in the majority of cases the overexposure produced no ill-effects. Nevertheless, it is considered highly likely that in individuals suffering from cardiac ailments, or in the case of pregnant women, the consequences of overexposure would be more severe, and therefore should be avoided. This report describes the findings of the investigation, and recommends improved ventilation levels to ensure a minimum of 10 air exchanges per hour and constant monitoring of carbon monoxide levels during similar events. 2 refs., figs.

EPR study of manganese(II) binding to 55'-ATP, hemoglobin, and hemocyanin

Energy Technology Data Exchange (ETDEWEB)

Chang, S.S. (Duquesne Univ., Pittsburgh); Li, N.C.; Pratt, D.W.

1975-01-01

Several divalent metal ions affect the oxygen affinity of hemoglobin and hemocyanin. It is important, therefore, to understand the nature of metal-ion binding to these proteins. By comparing the EPR spectra of Mn(II), 0.001 M, in the absence and presence of carboxyhemoglobin or Limulus oxyhemocyanin (pH 7.3, Trizma buffer), the number of Mn binding sites, n, and the binding constant, K, can be determined. For carboxyhemoglobin, HbCO, we find 0.5 Mn binding sites per heme, K = 450 M/sup -1/. Each hemoglobin tetramer therefore binds two manganous ions suggesting that Mn(II), like Cu(II), may bind preferentially to one of the two types of subunits in hemoglobin. For hemocyanin, HcO/sub 2/, we find n = 5.8, K = 1.55 x 10/sup 3/ M/sup -1/. Each oxyhemocyanine therefore binds approximately six manganous ions, and the binding constant is three times larger than that for HbCO. We have also carried out similar experiments on 5'-ATP, and on solutions of HbCO and ATP containing McCl/sub 2/ or ZnCl/sub 2/. Zn(II) effectively competes with Mn(II) in binding hemoglobin and ATP, whereas Mg(II) does not, in accord with expectations from data on oxygen affinity of hemoglobin. (auth)

Occult Carbon Monoxide Poisoning

OpenAIRE

Kirkpatrick, John N.

1987-01-01

A syndrome of headache, fatigue, dizziness, paresthesias, chest pain, palpitations and visual disturbances was associated with chronic occult carbon monoxide exposure in 26 patients in a primary care setting. A causal association was supported by finding a source of carbon monoxide in a patient's home, workplace or vehicle; results of screening tests that ruled out other illnesses; an abnormally high carboxyhemoglobin level in 11 of 14 patients tested, and abatement or resolution of symptoms ...

Precision of a new bedside method for estimation of the circulating blood volume

DEFF Research Database (Denmark)

Christensen, P; Eriksen, B; Henneberg, S W

1993-01-01

The present study is a theoretical and experimental evaluation of a modification of the carbon monoxide method for estimation of the circulating blood volume (CBV) with respect to the precision of the method. The CBV was determined from measurements of the CO-saturation of hemoglobin before and a......, determination of CBV can be performed with an amount of CO that gives rise to a harmless increase in the carboxyhemoglobin concentration.(ABSTRACT TRUNCATED AT 250 WORDS)...

Non-invasive multi wavelengths sensorsystem for measuring carboxy-and methemoglobin

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Gewiß Helge

2017-09-01

Full Text Available Standard pulse oximetry only measures the functional derivatives oxyhemoglobin (O2Hb and deoxyhemoglobin (HHb to calculate the arterial oxygenation. However, the two dysfunctional hemoglobin derivatives carboxyhemoglobin (COHb and methemoglobin (MetHb are of much interest. The gold standard detecting abnormal concentration of COHb or MetHb is the blood gas analysis (BGA. In this paper a non-invasive method for measuring these derivatives and a setup for validation is presented.

Effects of air pollution from cars on police health in Paris; Effets de la pollution atmospherique d`origine automobile sur la sante des policiers affectes a la circulation a Paris

Energy Technology Data Exchange (ETDEWEB)

Bugajny, Ch.; Delaunay, C.; Viellard, H. [Prefecture de Police de Paris, 75 (France). Laboratoire Central; Petit-Coviaux, F.; Coiron, C.; Squinazi, F. [Laboratoire d`Ygiene de la Ville de Paris, 75 (France); Lecomte, D. [Prefecture de Police de Paris, 75 (France). Dirt. Prevention des Risques Sanitaires

1999-01-01

The aim of this study was to assess the effects of car pollution on police health in Paris, more particularly for policemen who are working near streets and crossroads. A population of non-exposed policemen has also been studied as a reference. This work included individual exposure measurements to some urban pollution main indicators and biological determinations to estimate the effects of these pollutants on health. Biological measurements in blood, including determinations of carboxyhemoglobin and lead, were realized on 204 men and women employed by the Prefecture de Police. Carbon monoxide and benzene individual exposure had been measured on 38 men among these policemen, by the use of individual analyzers or pump sampling. Three classes of exposure, which depends on police activities, could be characterized according to CO and benzene exposure levels and carboxyhemoglobin concentrations. Carboxyhemoglobin mean values before traffic exposure are four to five times more important for smokers (4.5 % HbCO) than for no-smokers (1.0 % HbCO). After work, these mean values are respectively 5.3 % and 1.1 % HbCO). We could conclude that no-smokers agents don`t reach the WHO value (2.5 % HbCO), which should not been exceeded, while average HbCO percentage for smokers after work is twice more important than OMS value. So, smoking contributes to higher levels of CO in blood than car exhaust pollutants, even for high air pollutants concentrations. CO exposure levels are lower than the WHO recommendations for all the durations, and therefore lower than limit values fixed in working places (55 mg.m{sup 3} for 8 hours). No level for airborne benzene is recommended by WHO, as this compound is carcinogenic to humans; WHO indicated that for an air concentration of 1 {mu}g.m{sup 3}, the estimated lifetime risk of leukaemia is 4.10{sup -6}. Individual benzene measurements are lower than limit concentrations for working place (16 mg.m{sup 3} for 8 hours). Lead blood levels, which

Oxygen affinity and acid-base status of human blood during exposure to hypoxia and carbon monoxide

Energy Technology Data Exchange (ETDEWEB)

Mulhausen, R.O.; Astrup, P.; Mellemgaard, K.

1968-01-01

Eight individuals exposed to hypoxia at altitude or simulated altitude in hypobaric chamber had hemoglobin with a decreased affinity for O/sub 2/ as shown by a shift in the dissociation curve to the right (about 4 mm at 3450 m). Acid-base changes could not explain shift. Intermittent CO doses to maintain approx. 15% carboxyhemoglobin produced the typical shift to the left. Acid-base changes were insignificant. Proposed adaptation mechanism for combating hypoxia does not work for CO poisoning.

Systems for animal exposure in full-scale fire tests

Science.gov (United States)

Hilado, C. J.; Cumming, H. J.; Kourtides, D. A.; Parker, J. A.

1977-01-01

Two systems for exposing animals in full-scale fire tests are described. Both systems involve the simultaneous exposure of two animal species, mice and rats, in modular units; determination of mortality, morbidity, and behavioral response; and analysis of the blood for carboxyhemoglobin. The systems described represent two of many possible options for obtaining bioassay data from full-scale fire tests. In situations where the temperatures to which the test animals are exposed can not be controlled, analytical techniques may be more appropriate than bioassay techniques.

Hematological and biochemical effects of chronic CO exposure on the Japanese quail

Energy Technology Data Exchange (ETDEWEB)

Jaeger, J.J.; McGrath, J.J.

1975-01-01

Japanese Quail were exposed to a concentration of 300 to 350 ppm CO to maintain an equilibrium carboxyhemoglobin concentration of 30% for a period of 4 weeks. Compared to a control group of birds maintained in an identical chamber, the CO-exposed quail demonstrated increases in hematocrit ratio and hemoglobin concentration. At the end of the exposure period, the CO-exposed quail had significantly larger plasma glucose concentrations than the control birds. Cardiac and skeletal muscle carbohydrate stores were not affected by chronic CO exposure.

Some indices of bodily reaction of traffic controllers to atmospheric pollution by automobile exhaust gases

Energy Technology Data Exchange (ETDEWEB)

Partsef, D.P.; Bessonova, N.A.

1976-12-01

The authors studied pollution of the atmospheric air at 20 posts on Moscow streets with various intensity of auto traffic. They sampled for carbon monoxide, hydrocarbons, nitrogen dioxide, dust, acrolein, oxidants, and ozone and found that the concentration of these substances was a direct function of the intensity of auto flow and a reverse function of the width of the highway. Traffic controllers exhibited increased carboxyhemoglobin blood levels, decrease in bactericidal properties and increase in number of colonies of skin microorganisms. The controller complained in weariness, cardiovascular and gastrointestinal disturbances.

[Evaluation of changes in hemodynamic parameters after the use of electronic nicotine delivery systems among regular cigarette smokers].

Science.gov (United States)

Czogała, Jan; Cholewiński, Mateusz; Kutek, Agnieszka; Zielińska-Danch, Wioleta

2012-01-01

A relatively new device, described by producers as a device to help smokers quit, nicotine inhaler is an electronic (e-cigarette). Its mission is to provide the body with small doses of nicotine behavior "ceremonial" burning product is not tested for efficacy and toxicity The aim of this study was to compare the effects of nicotine absorbed from cigarette conventional and electronic changes in systolic and diastolic blood pressure and heart rate. Because of the potential interaction of carbon monoxide contained in cigarette smoke and nicotine conventional to changes on the parameters is also going to examine changes in the concentration of carboxyhemoglobin after smoking cigarettes and using e-cigarettes. study group consisted of 42 people, including 21 women and 21 men aged from 18 to 62 years who declared daily cigarette smoking. In this study it was found that as a result of cigarette smoking are increasing all the analyzed conventional hemodynamic parameters, these increases probably normally associated with nicotine absorbed by the smoker with the smoke. It was also a clear increase in carboxyhemoglobin, which is associated with a high concentration of carbon monoxide in cigarette smoke. If you use the e-cigarettes tested were observed increases in diastolic blood pressure and pulse, but none of the parameters did not change significantly, indicating that either the use of e-cigarette by the respondents did not supply the body with absorbable nicotine or for the increase in haemodynamic parameters studied did not correspond only nicotine but also other smoke constituents that interact with nicotine to the smoker body as carbon monoxide.

Maintain levels of nicotine but reduce other smoke constituents: a formula for ''less-hazardous'' cigarettes

Energy Technology Data Exchange (ETDEWEB)

Robinson, J.C.; Young, J.C.; Rickert, W.S.

1984-09-01

Twenty-two volunteers who smoked more than 20 cigarettes with ''high'' nicotine yields (0.8 to 1.2 mg) per day participated in an 8-week study designed to test the hypothesis that smoking cigarettes with a constant level of nicotine but reduced deliveries of tar, carbon monoxide, and hydrogen cyanide leads to a decrease in smoke absorption. All subjects smoked their usual high-nicotine brand for the first 3 weeks (P1), and the absorption of smoke constituents was determined from levels of thiocyanate and cotinine in saliva and serum, levels of carbon monoxide in expired air, and levels of carboxyhemoglobin in the blood. During the final 5 weeks (P2), the treatment group (16 subjects) switched to the ''light'' version of their usual brands (similar yields of nicotine but with reduced yields of tar, carbon monoxide, and hydrogen cyanide); the control group (6 subjects) smoked their usual brands for the duration of the study. Average levels of cotinine for the subjects who switched during P2 were not significantly different from those of the control group as was expected. Slight reductions were noted in average expired-air carbon monoxide levels, blood carboxyhemoglobin, and saliva thiocyanate, but these reductions were smaller than anticipated based on brand characteristics. The results suggest that the ratio of smoke constituents is different when individuals, rather than machines, smoke cigarettes. Yields determined under subject-defined conditions are necessary in order to properly evaluate the role of nicotine in the design of ''less-hazardous'' cigarettes.

SANGUINATE (PEGylated Carboxyhemoglobin Bovine): Mechanism of Action and Clinical Update.

Science.gov (United States)

Abuchowski, Abraham

2017-04-01

Historically, blood substitutes were under development that would provide oxygen carrying capacity as well as fluid replacement for both trauma and surgical indications. Their development was halted by the inability of the products to deliver therapeutic amounts of oxygen targeted to hypoxic tissue as well as from the inherent toxicity of the molecules. This led to the concept of an oxygen therapeutic that would be targeted for indications caused by anemia/ischemia/hypoxia but would not exhibit the toxicity that plagued earlier products. The complex pathophysiology of diseases such as sickle cell and hemorrhagic stroke not only has hypoxia as a pivotal event but also includes inflammation and vasoconstriction that perpetuate the oxygen deprivation. There is a need for an effective therapeutic that addresses the multiple events of inflammation and oxygen deprivation. SANGUINATE acts as a dual mode carbon monoxide (CO) and oxygen delivery therapeutic. SANGUINATE is designed not only to treat hypoxia but also to act on concurrent pathologies such as inflammation and reperfusion injury. This expands the potential therapeutic utility of SANGUINATE beyond anemia into indications such as early brain injury and delayed kidney graft function, where inflammation plays a pivotal pathological role as well as in indications such as sickle cell disease where the inflammation and hypoxia contribute to the development of comorbidities such as vaso-occlusive crisis. Clinical trials in multiple indications are underway. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Values of HbCO in 1000 inhabitants of Milan non exposed to occupational absorption of CO

Energy Technology Data Exchange (ETDEWEB)

Grisler, R.; Gobbi, A.; Giavardi, C.; Caimmi, G.; Soverini, R.; Botta, A.

1975-01-01

Carboxyhemoglobin levels for 1000 non-occupationally exposed inhabitants of Milan were determined. The study group consisted of smokers and non-smokers; among the former, only individuals refraining from smoking for at least 10 hr were tested. The upper limit of the normal range for HbCO values among non-smokers was 2.85%, while among heavy smokers it was 4.59%. Heavy smokers also showed higher HbCO levels than did moderate smokers. Elevated HbCO values were also observed among residents living in carbon monoxide-polluted urban areas as compared with those living in unpolluted rural areas.

Study of the effect of protracted occupational exposure to carbon monoxide

Energy Technology Data Exchange (ETDEWEB)

Lindgren, S.A.

1961-01-01

Examination of workers exposed to CO (ironworks, mines, gasworks, motor repair shops) revealed increased frequency of headaches relative to control counterparts in the same industries but no other symptoms attributable to chronic CO inhalation. (Mean carboxyhemoglobin (COHb) during working hours ranged from about 2.5% to almost 10% for exposed group and about 1 to 2% for comparative controls. A large volume of Scandinavian literature was built up because of use of producer gas in W.W. II. (Much of the literature does not include measurements of CO or COHb but assumes symptoms are proof of exposure.)

Efficacy and safety of inhaled carbon monoxide during pulmonary inflammation in mice.

Directory of Open Access Journals (Sweden)

Michael R Wilson

2010-07-01

Full Text Available Pulmonary inflammation is a major contributor to morbidity in a variety of respiratory disorders, but treatment options are limited. Here we investigate the efficacy, safety and mechanism of action of low dose inhaled carbon monoxide (CO using a mouse model of lipopolysaccharide (LPS-induced pulmonary inflammation.Mice were exposed to 0-500 ppm inhaled CO for periods of up to 24 hours prior to and following intratracheal instillation of 10 ng LPS. Animals were sacrificed and assessed for intraalveolar neutrophil influx and cytokine levels, flow cytometric determination of neutrophil number and activation in blood, lung and lavage fluid samples, or neutrophil mobilisation from bone marrow.When administered for 24 hours both before and after LPS, inhaled CO of 100 ppm or more reduced intraalveolar neutrophil infiltration by 40-50%, although doses above 100 ppm were associated with either high carboxyhemoglobin, weight loss or reduced physical activity. This anti-inflammatory effect of CO did not require pre-exposure before induction of injury. 100 ppm CO exposure attenuated neutrophil sequestration within the pulmonary vasculature as well as LPS-induced neutrophilia at 6 hours after LPS, likely due to abrogation of neutrophil mobilisation from bone marrow. In contrast to such apparently beneficial effects, 100 ppm inhaled CO induced an increase in pulmonary barrier permeability as determined by lavage fluid protein content and translocation of labelled albumin from blood to the alveolar space.Overall, these data confirm some protective role for inhaled CO during pulmonary inflammation, although this required a dose that produced carboxyhemoglobin values close to potentially toxic levels for humans, and increased lung permeability.

Does inhalation injury predict mortality in burns patients or require redefinition?

Directory of Open Access Journals (Sweden)

Youngmin Kim

Full Text Available Inhalation injury is known to be an important factor in predicting mortality in burns patients. However, the diagnosis is complicated by the heterogeneous presentation and inability to determine the severity of inhalation injury. The purpose of this study was to identify clinical features of inhalation injury that affect mortality and the values that could predict the outcome more precisely in burns patients with inhalation injury. This retrospective observational study included 676 burns patients who were over 18 years of age and hospitalized in the Burns Intensive Care Unit between January 2012 and December 2015. We analyzed variables that are already known to be prognostic factors (age, percentage of total body surface area (%TBSA burned, and inhalation injury and factors associated with inhalation injury (carboxyhemoglobin and PaO2/FiO2 [PF] ratio by univariate and multivariate logistic regression. Age group (odds ratio [OR] 1.069, p<0.001, %TBSA burned (OR 1.100, p<0.001, and mechanical ventilation (OR 3.774, p<0.001 were identified to be significant predictive factors. The findings for presence of inhalation injury, PF ratio, and carboxyhemoglobin were not statistically significant in multivariate logistic regression. Being in the upper inhalation group, the lower inhalation group, and having a PF ratio <100 were identified to be significant predictors only in univariate logistic regression analysis (OR 4.438, p<0.001; OR 2.379, p<0.001; and OR 2.765, p<0.001, respectively. History and physical findings are not appropriate for diagnosis of inhalation injury and do not predict mortality. Mechanical ventilation should be recognized as a risk factor for mortality in burns patients with inhalation injury.

Methyl tert-butyl ether (MTBE) detected in abnormally high concentrations in postmortem blood and urine from two persons found dead inside a car containing a gasoline spill.

Science.gov (United States)

Karinen, Ritva; Vindenes, Vigdis; Morild, Inge; Johnsen, Lene; Le Nygaard, Ilah; Christophersen, Asbjørg S

2013-09-01

Two deep frozen persons, a female and a male, were found dead in a car. There had been an explosive fire inside the car which had extinguished itself. On the floor inside the car were large pools of liquid which smelled of gasoline. The autopsy findings and routine toxicological analyses could not explain the cause of death. Carboxyhemoglobin levels in the blood samples were gasoline as a fuel oxygenate. Gasoline poisoning is likely to be the cause of the death in these two cases, and MTBE can be a suitable marker of gasoline exposure, when other volatile components have vaporized. © 2013 American Academy of Forensic Sciences.

Effect of air and water pollutants on human health

Energy Technology Data Exchange (ETDEWEB)

Rondia, D.

1973-01-01

Toxicological and epidemiological studies on the effects of air pollutants on human health are reviewed. The epidemiological approach is based on the study of the human population actually exposed to air pollutants in daily life. Levels of increasing toxicity were established for the commonest air pollutants such as lead, sulfur dioxide, nitrogen oxides, and various allergens. The effects of pollution on immunology and adaptation, of carbon monoxide on carboxyhemoglobin levels, of sulfur dioxide on mortality and morbidity in urban areas, of nitrogen oxides on electrolytes and glutathion, of ozone and NO/sub x/ on respiratory diseases, and of pollutants on chronic bronchitis are reviewed.

Electrocardiographic gating in positron emission computed tomography

International Nuclear Information System (INIS)

Hoffman, E.J.; Phelps, M.E.; Wisenberg, G.; Schelbert, H.R.; Kuhl, D.E.

1979-01-01

Electrocardiographic (ECG) synchronized multiple gated data acquisition was employed with positron emission computed tomography (ECT) to obtain images of myocardial blood pool and myocardium. The feasibility and requirements of multiple gated data acquisition in positron ECT were investigated for 13NH3, ( 18 F)-2-fluoro-2-D-deoxyglucose, and ( 11 C)-carboxyhemoglobin. Examples are shown in which image detail is enhanced and image interpretation is facilitated when ECG gating is employed in the data collection. Analysis of count rate data from a series of volunteers indicates that multiple, statistically adequate images can be obtained under a multiple gated data collection format without an increase in administered dose

Transplacental diffusion of carbon monoxide in human subjects

Energy Technology Data Exchange (ETDEWEB)

Friberg, L.; Nystroem, A.; Swanberg, H.

1959-01-01

Measurements were made of maternal and fetal carboxyhemoglobin (COHb) (converted from direct CO measurements) during CO exposure of anesthetized women undergoing abortions. Brief exposure of 22 women in 5 to 6 months of pregnancy to 1.5% CO for 5 minutes produced 15% maternal COHb initially, decreasing with time, and approximately 1 to 3% fetal COHb, increasing to equal or greater than the maternal value at 3 to 5 hours, and decreasing subsequently. Protracted exposure of 14 similar women to 1.5% CO for 5 minutes and 0.01% CO for 2 hours thereafter resulted in near-maternal fetal COHb values that were sustained longer than was maternal COHb after exposure.

Carbon monoxide poisoning-induced cardiomyopathy from charcoal at a barbecue restaurant: a case report.

Science.gov (United States)

Kim, Hyun-Jun; Chung, Yun Kyung; Kwak, Kyeong Min; Ahn, Se-Jin; Kim, Yong-Hyun; Ju, Young-Su; Kwon, Young-Jun; Kim, Eun-A

2015-01-01

Acute carbon monoxide poisoning has important clinical value because it can cause severe adverse cardiovascular effects and sudden death. Acute carbon monoxide poisoning due to charcoal is well reported worldwide, and increased use of charcoal in the restaurant industry raises concern for an increase in occupational health problems. We present a case of carbon monoxide poisoning induced cardiomyopathy in a 47-year-old restaurant worker. A male patient was brought to the emergency department to syncope and complained of left chest pain. Cardiac angiography and electrocardiography were performed to rule out acute ischemic heart disease, and cardiac markers were checked. After relief of the symptoms and stabilization of the cardiac markers, the patient was discharged without any complications. Electrocardiography was normal, but cardiac angiography showed up to a 40% midsegmental stenosis of the right coronary artery with thrombotic plaque. The level of cardiac markers was elevated at least 5 to 10 times higher than the normal value, and the carboxyhemoglobin concentration was 35% measured at one hour after syncope. Following the diagnosis of acute carbon monoxide poisoning induced cardiomyopathy, the patient's medical history and work exposure history were examined. He was found to have been exposed to burning charcoal constantly during his work hours. Severe exposure to carbon monoxide was evident in the patient because of high carboxyhemoglobin concentration and highly elevated cardiac enzymes. We concluded that this exposure led to subsequent cardiac injury. He was diagnosed with acute carbon monoxide poisoning-induced cardiomyopathy due to an unsafe working environment. According to the results, the risk of exposure to noxious chemicals such as carbon monoxide by workers in the food service industry is potentially high, and workers in this sector should be educated and monitored by the occupational health service to prevent adverse effects.

Analysis of patients presenting to the emergency department with carbon monoxide intoxication

Directory of Open Access Journals (Sweden)

Selim Yurtseven

2015-12-01

Full Text Available Objectives: Carbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT is of proven efficacy in the treatment of CO intoxication.The purpose of this study was to describe the general characteristics of carbon monoxide (CO intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT in these patients. Material and methods: Patients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively. Results: One hundred seventy-one patients were included; 140 (81.9% were poisoned by stoves, 18 (10.5% by hot water boilers and 10 in (5.8% by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5% of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%. One patient died after 15 session of HBOT. Conclusion: Although elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT. Keywords: Carbon monoxide intoxication, Hyperbaric oxygen, Troponin I, Echocardiography

Determination of Human Hemoglobin Derivatives.

Science.gov (United States)

Attia, Atef M M; Ibrahim, Fatma A A; Abd El-Latif, Noha A; Aziz, Samir W; Abdelmottaleb Moussa, Sherif A; Elalfy, Mohsen S

2015-01-01

The levels of the inactive hemoglobin (Hb) pigments [such as methemoglobin (metHb), carboxyhemoglobin (HbCO) and sulfohemoglobin (SHb)] and the active Hb [in the oxyhemoglobin (oxyHb) form] as well as the blood Hb concentration in healthy non pregnant female volunteers were determined using a newly developed multi-component spectrophotometric method. The results of this method revealed values of SHb% in the range (0.0727-0.370%), metHb% (0.43-1.0%), HbCO% (0.4-1.52%) and oxyHb% (97.06-98.62%). Furthermore, the results of this method revealed values of blood Hb concentration in the range (12.608-15.777 g/dL). The method is highly sensitive, accurate and reproducible.

Carbon monoxide toxicity. April 1978-November 1989 (A Bibliography from the Life Sciences Collection data base). Report for April 1978-November 1989

Energy Technology Data Exchange (ETDEWEB)

1990-03-01

This bibliography contains citations concerning the mechanism and clinical manifestations of carbon monoxide exposure, including the effects on the liver, cardiovascular, and nervous systems. Topics include carbon monoxide binding affinity studies with hemoglobin, measurement of carboxyhemoglobin in humans and various animal species, carbon monoxide levels as related to tobacco and marijuana smoke, occupational exposure and the NIOSH biological exposure index, symptomology and percent of blood CO, and intrauterine exposure. Air pollution, tobacco smoking, and occupational exposure are discussed as primary sources of carbon monoxide exposure. The effects of cigarette smoking on fetal development and health are excluded and examined in a separate bibliography. (This updated bibliography contains 237 citations, 16 of which are new entries to the previous edition.)

Carbon monoxide toxicity. January 1978-March 1989 (Citations from the Life Sciences Collection data base). Report for January 1978-March 1989

Energy Technology Data Exchange (ETDEWEB)

1989-03-01

This bibliography contains citations concerning the mechanism and clinical manifestations of carbon monoxide exposure, including the effects on the liver, cardiovascular, and nervous systems. Topics include carbon monoxide binding affinity studies with hemoglobin, measurement of carboxyhemoglobin in humans and various animal species, carbon monoxide levels as related to tobacco and marijuana smoke, occupational exposure and the NIOSH biological exposure index, symptomology and percent of blood CO, and intrauterine exposure. Air pollution, tobacco smoking, and occupational exposure are discussed as primary sources of carbon monoxide exposure. The effects of cigarette smoking on fetal development and health are excluded and examined in a separate bibliography. (This updated bibliography contains 221 citations, 19 of which are new entries to the previous edition.)

Health effects of carbon monoxide environmental pollution

Energy Technology Data Exchange (ETDEWEB)

1974-01-01

Carbon monoxide's (CO) chronic effects on man, its sources, and measuring methods are reviewed, and guidelines to determine health criteria are considered. The European data exchange included CO measuring methods in air and blood and their use in survey and experimental work, atmospheric CO pollution and sampling methods in urban thoroughfares and road tunnels in the European countries, a population survey of carboxyhemoglobin levels from cigarette smoking and atmospheric exposure, and physiological kinetics (uptake, distribution, and elimination) of CO inhalation. Additional topics are CO and the central nervous system, effects of moderate CO exposure on the cardiovascular system and on fetal development, and the current views on existing air quality criteria for CO.

A Rare Cause of Chronic Headache that May Be Misdiagnosed as Migraine: Chronic Carbon Monoxide Poisoning

Directory of Open Access Journals (Sweden)

Mehmet Kenan KANBUROGLU

2014-09-01

Full Text Available SUMMARY: Differential diagnosis of primary headache disorders can be challenging for physicians. Although the association of headache with acute carbon monoxide intoxication is very well-defined, in refractory nonspecific headaches associated with chronic low dose exposure to carbon monoxide, CO intoxication is usually overlooked, mostly due to vague symptoms. Herein we present a 15-year-old female patient with chronic carbon monoxide poisoning who was undergoing two years of follow-up care for migraines. Chronic carbon monoxide intoxication may mimic the episodic nature and familial predisposition of migraine attacks. Normal carboxyhemoglobin levels do not exclude the diagnosis, and smoking is a confounding factor. In emergency rooms, patients presenting with headaches had higher levels of carboxyhemoglobin, but, as far as we know, there have been no studies investigating carboxyhemoglobin levels in migraine patients. Chronic carbon monoxide poisoning should be suspected in migraine patients, especially if the attacks occur during winter months. ÖZET: Primer baş ağrısında ayırıcı tanının yapılması bazen doktorlar açısından zor olabilmektedir. Literatürde karbon monoksit ile baş ağrısı arasındaki ilişki çok iyi ortaya konulmuş olmasına karşın, dirençli ve nonspesifik başağrısı nedenlerinden biri olan kronik düşük doz karbon monoksit maruziyeti kendine özgü bulgusu olmadığından sıklıkla atlanmaktadır. Bu yazıda, iki yıl migren tanısı ile takip ve tedavi edilen kronik karbon monoksit zehirlenmesi olan bir olgu sunuldu. Kronik karbon monoksit zehirlenmesi epizodik paterni ve aile fertlerinde benzer şikayetlerin olması nedeniyle migren ataklarını andırabilmektedir. Karboksihemoglobin konsantrasyonlarının normal saptanması tanıyı ekarte ettirmemekte, ayrıca sigara kullanımı da karıştırıcı bir faktör olabilmektedir. Acil servislerine baş ağrısı ile başvuran hastalar

SPECTROPHOTOMETRY OF HEMOGLOBIN - ABSORPTION-SPECTRA OF RAT OXYHEMOGLOBIN, DEOXYHEMOGLOBIN, CARBOXYHEMOGLOBIN, AND METHEMOGLOBIN

NARCIS (Netherlands)

ZIJLSTRA, WG; BUURSMA, A; FALKE, HE; CATSBURG, JF

The absorptivity at 540 nm of methemoglobincyanide from rat blood was determined on the basis of iron and found to be equal to the established value for human methemoglobincyanide (11,01/mmol/cm). On this basis the absorption spectra of the common derivatives were determined for rat hemoglobin.

Spectrophotometry of hemoglobin : Absorption spectra of bovine oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin

NARCIS (Netherlands)

Zijlstra, WG; Buursma, A

1997-01-01

The absorptivity at 540 nm of bovine hemiglobincyanide (cyanmethemoglobin) was determined on the basis of the iron content and found to be equal to the established value for human hemiglobincyanide (11.0 L . mmol(-1).cm(-1)). On this basis the absorption spectra of the common derivatives were

Occult carbon monoxide poisoning.

Science.gov (United States)

Kirkpatrick, J N

1987-01-01

A syndrome of headache, fatigue, dizziness, paresthesias, chest pain, palpitations and visual disturbances was associated with chronic occult carbon monoxide exposure in 26 patients in a primary care setting. A causal association was supported by finding a source of carbon monoxide in a patient's home, workplace or vehicle; results of screening tests that ruled out other illnesses; an abnormally high carboxyhemoglobin level in 11 of 14 patients tested, and abatement or resolution of symptoms when the source of carbon monoxide was removed. Exposed household pets provided an important clue to the diagnosis in some cases. Recurrent occult carbon monoxide poisoning may be a frequently overlooked cause of persistent or recurrent headache, fatigue, dizziness, paresthesias, abdominal pain, diarrhea and unusual spells.

Carbon monoxide toxicity. (Latest citations from the Life Sciences Collection database). NewSearch

Energy Technology Data Exchange (ETDEWEB)

1994-10-01

The bibliography contains citations concerning the mechanism and clinical manifestations of carbon monoxide (CO) exposure, including the effects on the liver, cardiovascular, and nervous systems. Topics include studies of the carbon monoxide binding affinity with hemoglobin, measurement of carboxyhemoglobin in humans and various animal species, carbon monoxide levels resulting from tobacco and marijuana smoke, occupational exposure and the NIOSH (National Institute for Occupational Safety and Health) biological exposure index, symptomology and percent of blood CO, and intrauterine exposure. Air pollution, tobacco smoking, and occupational exposure are discussed as primary sources of carbon monoxide exposure. The effects of cigarette smoking on fetal development and health are excluded and examined in a separate bibliography. (Contains a minimum of 137 citations and includes a subject term index and title list.)

Carbon monoxide toxicity. (Latest citations from the Life Sciences Collection data base). Published Search

Energy Technology Data Exchange (ETDEWEB)

1992-08-01

The bibliography contains citations concerning the mechanism and clinical manifestations of carbon monoxide (CO) exposure, including the effects on the liver, cardiovascular, and nervous systems. Topics include studies of the carbon monoxide binding affinity with hemoglobin, measurement of carboxyhemoglobin in humans and various animal species, carbon monoxide levels resulting from tobacco and marijuana smoke, occupational exposure and the NIOSH (National Institute for Occupational Safety and Health) biological exposure index, symptomology and percent of blood CO, and intrauterine exposure. Air pollution, tobacco smoking, and occupational exposure are discussed as primary sources of carbon monoxide exposure. The effects of cigarette smoking on fetal development and health are excluded and examined in a separate bibliography. (Contains a minimum of 172 citations and includes a subject term index and title list.)

Postmortem aviation forensic toxicology: an overview.

Science.gov (United States)

Chaturvedi, Arvind K

2010-05-01

An overview of the subtopic aviation combustion toxicology of the field of aerospace toxicology has been published. In a continuation of the overview, the findings associated with postmortem aviation forensic toxicology are being summarized in the present overview. A literature search for the period of 1960-2007 was performed. The important findings related to postmortem toxicology were evaluated. In addition to a brief introduction, this overview is divided into the sections of analytical methods; carboxyhemoglobin and blood cyanide ion; ethanol; drugs; result interpretation; glucose and hemoglobin A(1c); and references. Specific details of the subject matter were discussed. It is anticipated that this overview will be an outline source for aviation forensic toxicology within the field of aerospace toxicology.

Status epilepticus and cardiopulmonary arrest in a patient with carbon monoxide poisoning with full recovery after using a neuroprotective strategy: a case report

Directory of Open Access Journals (Sweden)

Abdulaziz Salman

2012-12-01

Full Text Available Abstract Introduction Carbon monoxide poisoning can be associated with life-threatening complications, including significant and disabling cardiovascular and neurological sequelae. Case presentation We report a case of carbon monoxide poisoning in a 25-year-old Saudi woman who presented to our facility with status epilepticus and cardiopulmonary arrest. Her carboxyhemoglobin level was 21.4 percent. She made a full recovery after we utilized a neuroprotective strategy and normobaric oxygen therapy, with no delayed neurological sequelae. Conclusions Brain protective modalities are very important for the treatment of complicated cases of carbon monoxide poisoning when they present with neurological toxicities or cardiac arrest. They can be adjunctive to normobaric oxygen therapy when the use of hyperbaric oxygen is not feasible.

Pathology of carbon monoxide poisoning in two cats.

Science.gov (United States)

Sobhakumari, Arya; Poppenga, Robert H; Pesavento, J Brad; Uzal, Francisco A

2018-03-05

Carbon monoxide (CO), a common cause of poisoning in human beings has also been implicated in the death of animals. Though there are multiple studies on CO poisoning and relevant lethal blood COHb concentrations in humans, there are no reliable reports of diagnostic lethal carboxyhemoglobin percentage of saturation (COHb%) in cats. Additionally, due to shared housing environments, exposures to companion animals can be a surrogate for lethal exposures in human beings and provide valuable information in concurrent forensic investigations. Two adult Singapura brown ticked cats were submitted to the California Animal Health and Food Safety Laboratory (CAHFS) for necropsy and diagnostic work-up. These animals were found dead along with their two deceased owners. Similar lesions were observed in both cats. At necropsy, gross lesions consisted of multifocal, large, irregular, bright red spots on the skin of the abdomen and the inner surface of ear pinnae, bright red muscles and blood. The carcasses, and tissues fixed in formalin retained the bright red discoloration for up to two weeks. Microscopic lesions included diffuse pulmonary congestion and edema, and multifocal intense basophilia of cardiomyocytes mostly affecting whole fibers or occasionally a portion of the fiber. Based on the clinical history,gross and microscopic changes, cyanide or carbon monoxide poisoning was suspected. Blood samples analyzed for carbon monoxide showed 57 and 41% carboxyhemoglobin COHb%. Muscle samples were negative for cyanide. There are no established reference values for lethal COHb concentration in cats. The COHb % values detected in this case which fell within the lethal range reported for other species, along with the gross lesions and unique histological findings in the heart suggest a helpful criteria for diagnosis of CO intoxication associated death in cats. This case demonstrates that since pets share the same environment as human beings and often are a part of their activities

Lethal carbon monoxide toxicity in a concrete shower unit.

Science.gov (United States)

Heath, Karen; Byard, Roger W

2018-05-23

A 47-year-old previously-well woman was found dead on the floor of a shower cubicle on a property in rural South Australia. The impression of the attending doctor and police was of collapse due to natural disease. Although there was significant stenosing coronary artery atherosclerosis found at autopsy, cherry pink discoloration of tissues prompted measurement of the blood carboxyhemoglobin level which was found to be 55%. The source of the gas was a poorly-maintained hot water heater that was mounted on the inside wall of the shower. Construction of the shower using an impermeable concrete rain water tank had caused gas accumulation when the water heater malfunctioned. Had lethal carbon monoxide exposure not been identified others using the same shower unit would also have been at risk.

Carbon monoxide toxicity. (Latest citations from the Life Sciences Collection database). Published Search

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-10-01

The bibliography contains citations concerning the mechanism and clinical manifestations of carbon monoxide (CO) exposure, including the effects on the liver, cardiovascular, and nervous systems. Topics include studies of the carbon monoxide binding affinity with hemoglobin, measurement of carboxyhemoglobin in humans and various animal species, carbon monoxide levels resulting from tobacco and marijuana smoke, occupational exposure and the NIOSH (National Institute for Occupational Safety and Health) biological exposure index, symptomology and percent of blood CO, and intrauterine exposure. Air pollution, tobacco smoking, and occupational exposure are discussed as primary sources of carbon monoxide exposure. The effects of cigarette smoking on fetal development and health are excluded and examined in a separate bibliography.(Contains 50-250 citations and includes a subject term index and title list.) (Copyright NERAC, Inc. 1995)

Carbon monoxide toxicity. (Latest citations from the Life Sciences Collection database). Published Search

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-10-01

The bibliography contains citations concerning the mechanism and clinical manifestations of carbon monoxide (CO) exposure, including the effects on the liver, cardiovascular, and nervous systems. Topics include studies of the carbon monoxide binding affinity with hemoglobin, measurement of carboxyhemoglobin in humans and various animal species, carbon monoxide levels resulting from tobacco and marijuana smoke, occupational exposure and the NIOSH (National Institute for Occupational Safety and Health) biological exposure index, symptomology and percent of blood CO, and intrauterine exposure. Air pollution, tobacco smoking, and occupational exposure are discussed as primary sources of carbon monoxide exposure. The effects of cigarette smoking on fetal development and health are excluded and examined in a separate bibliography. (Contains 50-250 citations and includes a subject term index and title list.) (Copyright NERAC, Inc. 1995)

Learning of conditioned reflexes of the Wistar rat under intermittent action of low CO concentrations

Energy Technology Data Exchange (ETDEWEB)

Zorn, H.

1972-04-01

The influence of an intermittent long-time exposure to a concentration of 150 ppm carbon monoxide on the ability to learn conditioned reflexes was investigated with Wistar rats. Half the 80 rats employed and divided into intelligence groups were exposed to this concentration at night five times for 8 hr weekly. The carboxyhemoglobin level in the blood of these animals increased to 7-13 percent. After an adequate interval for CO elimination, the rats exposed and the control animals were trained to develop a conditioned flight reflex. At a later date, the results were ascertained. With regard to the progress in learning this action, the CO-exposed animals showed a significant reduction in performance (longer learning time, more frequent deficient behavior, and inclination for stupor and anxious denial).

Studies of significant properties of filter-type self rescuer for its use in underground coal mine in carbon monoxide exposure

Energy Technology Data Exchange (ETDEWEB)

Kumar, A.; Mondal, P.C. [Central Institute of Mining and Fuel Research, Dhanbad (India)

2007-07-01

CO is a highly toxic gas; it is the outcome of fire or explosion in underground coal mines. It combines with hemoglobin of coal mine workers and carboxyhemoglobin forms, which reduces the oxygen carrying capacity of blood. A little intake of CO gas, even 0.1% in atmosphere, causes respiratory failure. Filter-type self rescuers (FSR) are a life-saving gas mask breathing apparatus against CO exposure in underground coal mine. The quality of FSR was evaluated in respect of its duration for use, CO conversion by hopcalite, breathing resistance, leak tightness properties, and so on. A scope of improvement is observed in cartridge of self rescuer as well as in the clauses of BIS 9563-1980 in order to increase the duration and improvement in the quality of self rescuers. 12 refs., 2 tabs.

Dichloromethane and carbon monoxide inhalation: carboxyhemoglobin addition, and drug metabolizing enzymes in rat

Energy Technology Data Exchange (ETDEWEB)

Kurppa, K.; Kivistoe, H.; Vainio, H.

1981-09-01

Male Wistar rats were exposed for 3 h to 100 ppm CO, 1,000 ppm dichloromethane, or to their combination. Exposure to dichloromethane alone or in combination with CO doubled the ethoxycoumarin O-deethylase activity in the kidney microsomes but not in the liver. An additive effect on blood COHb concentration by simultaneous exposure to CO and dichloromethane was observed. The mechanism of the additive effect is discussed.

ABSORPTION-SPECTRA OF HUMAN FETAL AND ADULT OXYHEMOGLOBIN, DE-OXYHEMOGLOBIN, CARBOXYHEMOGLOBIN, AND METHEMOGLOBIN

NARCIS (Netherlands)

ZIJLSTRA, WG; MEEUWSENVANDERROEST, WP

We determined the millimolar absorptivities of the four clinically relevant derivatives of fetal and adult human hemoglobin in the visible and near-infrared spectral range (450-1000 nm). As expected, spectral absorption curves of similar shape were found, but the small differences between fetal and

Validation of tomographic measurement of cerebral blood volume with C-11-labeled carboxyhemoglobin

International Nuclear Information System (INIS)

Phelps, M.E.; Huang, S.C.; Hoffman, E.J.; Kuhl, D.E.

1979-01-01

Red blood cells, tagged with C-11 administration of 11 CO gas, have been used to portray the distribution of blood in the brain. To date, however, the accuracy of this approach has not been validated. We have performed in vitro measurements of regional cerebral blood volume (CBV) with red blood cells labeled with C-11 and Cr-51 in four dogs and two rhesus monkeys. These studies yielded a ratio of CBV/sub C-1/ to CBV/sub Cr-11/ of 1.02 +- 0.03 (s.d.) from 92 samples. A least-squares fit to these data showed CBV/sub C-11/ = 1.01 CBV/sub Cr-51/ + 0.037; P much 11 CO-RBC gave coefficients of variation of +- 2.8% and +- 4.8% for cross-sectional CBV and regional (approx.4 cm 2 ) CBV over an 80-min period. The average human CBV was found to be 4.2 +- 0.4 cc blood per 100 g tissue. Clear tomographic delineation of the distribution of CBV in human subjects is achieved with ECT, which provides a ''live'' measurement of this parameter of cerebral hemodynamics. These data demonstrate that 11 CO administered by single-breath inhalation is a reliable and accurate blood tracer for measurement of CBV with ECT

Cerebral blood volume measurement using radioactive carboxyhemoglobin and positron emission tomography. Chapter 26

International Nuclear Information System (INIS)

Kanno, Iwao; Murakami, Matsutaro; Miura, Shuichi; Iida, Hidehiro; Takahashi, Kazuhiro; Sasaki, Hiroshi; Uemura, Kazuo

1988-01-01

This paper aims to describe the technical basis for this simplest cerebral blood volume (CBV) measurement using CO-labelled red blood cells and PET and to clarify the error sources in the technique which will become critical when we perform studies on physiological activation of CBV. 17 refs.; 6 figs.; 2 tabs

Interactions of carbon monoxide and hemoglobin at high altitude

Energy Technology Data Exchange (ETDEWEB)

Collier, C.R. (Univ. of Southern California Medical Center, Los Angeles); Goldsmith, J.R.

1983-01-01

The health risks to U.S. populations who are exposed to ambient carbon monoxide and live at altitudes (such as Denver, Salt Lake City, and Albuquerque) were evaluated using a set of mathematical models. The assumption that a given increase in carboxyhemoglobin would require a more stringent volumetric air quality standard was tested. The results using the model predict that the 8-h or 1-h standards adopted for sea level condition need not be altered to protect individuals against health risks at altitude, if the standards are in volumetric terms. They would need to be reduced if the standards are left in gravimetric terms. If the guideline is to be based on a given decrement of oxygen tension, many other variables must be specified, but expected differences in ambient carbon monoxide have a small impact compared to the effect of altitude itself.

Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients.

Science.gov (United States)

Cervellin, Gianfranco; Comelli, Ivan; Rastelli, Gianni; Picanza, Alessandra; Lippi, Giuseppe

2014-12-01

The aim of this study was to assess the role of blood lactate levels at admission in carbon monoxide (CO)-poisoned patients for establishing severity of poisoning and short term prognosis. All cases of CO poisoning visited in the emergency department during the years 2012 and 2013 were retrieved from the hospital database. The concentration of COHb and lactate was assessed in arterial blood in all patients with suspected CO poisoning, along with the plasma concentration of troponin I (TnI). The control population for TnI results consisted in 125 blood donors. Twenty three (61%) out of 38 CO-poisoned patients underwent hyperbaric oxygen (HBO) treatment, and 10 (26%) were admitted to a hospital ward. A significant correlation was found between lactate and COHb (r=0.54; p99th percentile compared to 2% controls (p=0.003). The odds ratio for detectable TnI and TnI >99th percentile in CO-poisoned patients were 13.1 (p<0.001) and 7.6 (p=0.006), respectively. Initial blood lactate level may be useful for risk stratification of CO-poisoned patients, especially for predicting hospitalization. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Environmental pollution by automotive source. II. Local inhabitants's reaction to environmental pollution

Energy Technology Data Exchange (ETDEWEB)

Aizawa, R; Hirara, K; Izumi, T; Mori, S

1975-04-01

The reaction of inhabitants to auto exhaust, noise, and vibration was surveyed in commercial and residential quarters by inquiries and measurement of the carbon monoxide in expired air of the inhabitants. About 65 percent of the inhabitants of busy quarters complained of severe reactions to auto exhaust, noise, and vibration; physical effects included headache, absentmindedness, loss of appetite, prickling of eyes, pain in the throat, and frequent colds. The concentration of carbon monoxide in the expired air of inhabitants of residential quarters was about 5 ppM, and in the busy quarter with much motor traffic the concentration was about 10 ppM. The concentration of carboxyhemoglobin in blood of the latter averaged 2.5 to 2.6 percent, and the former was 1.5 percent. The data were taken among non-smokers, and there were socio-economic differences among inhabitants of both quarters.

Evidence of Premeditation in Skin Messages in Suicide.

Science.gov (United States)

Byard, Roger W

2016-03-01

A 34-year-old man with manic-depressive disorder was found dead sitting in a vehicle with a hose running from the exhaust pipe to the cabin. Numerous suicide notes were found inside his house. At autopsy, the decedent was wearing jeans and a long-sleeved windcheater. Upon removal of his clothes, a series of messages were also found written on the legs and forearm. Death was due to carbon monoxide toxicity with a blood level of carboxyhemoglobin of 84%. Skin messages represent a rare form of suicide note that may suggest that a suicide has not been planned, as the decedent may have used the nearest surface to write on. This case demonstrates, however, that skin messages may be more organized, being written prior to dressing and setting up the fatal episode. They also may compliment other notes and messages. © 2015 American Academy of Forensic Sciences.

Carbon monoxide exposure and information processing during perceptual-motor performance

Energy Technology Data Exchange (ETDEWEB)

Mihevic, P.M.; Gliner, J.A.; Horvath, S.M.

1983-01-01

This study examined the influence of exposure to ambient carbon monoxide resulting in final carboxyhemoglobin (COHb) levels of approximately 5.0% on the ability to process information during motor performance. Subjects (n . 16) performed a primary reciprocal tapping task and a secondary digit manipulation task singly and/or concurrently during 2.5 h exposure to room air (0 ppm CO) or 100 ppm CO. Five levels of tapping difficulty and two levels of digit manipulation were employed. Tapping performance was unaffected when COHb levels were as high as 5%. However, at this level of COHb it was noted that CO exposure interacted with task difficulty of both tasks to influence reaction time on the digit manipulation task. It was concluded that motor performance was not influenced by exposure to CO leading to COHb concentrations of 5%. Task difficulty was a significant factor mediating behavioral effects of CO exposure.

Heavy metal pollution among autoworkers. II. Cadmium, chromium, copper, manganese, and nickel

Energy Technology Data Exchange (ETDEWEB)

Clausen, J.; Rastogi, S.C.

1977-08-01

Garages and auto-repair workshops may be polluted with other heavy metals besides lead. Blood of autoworkers with high lead content was analyzed for cadmium, chromium, copper, manganese, nickel, ALAD activity and carboxyhaemoglobin level. Cadmium and copper levels in blood of autoworkers were comparable with those of the control subjects while chromium and nickel levels were significantly higher (P < 0.01 for both metals), and scattered raised values of manganese were found. There was no significant mutual correlation between levels of various heavy metals determined in whole blood. High copper levels were slightly related to decreasing ALAD activity (P < 0.1). Nineteen percent of autoworkers were found to have an abnormally high blood level of carboxyhemoglobin. The amount of particulate heavy metal in autoworkshop air was not related to biochemical abnormalities found in the autoworkers. Various sources of pollution of these heavy metals in autoworkshops are discussed.

Carbon monoxide exposure and information processing during perceptual-motor performance

Energy Technology Data Exchange (ETDEWEB)

Mihevic, P.M.; Gliner, J.A.; Horvath, S.M.

1983-04-01

This study examined the influence of exposure to ambient carbon monoxide resulting in final carboxyhemoglobin (COHb) levels of approximately 5.0% on the ability to process information during motor performance. Subjects (n = 16) performed a primary reciprocal tapping task and a secondary digit manipulation task singly and/or concurrently during 2.5 h exposure to room air (0 ppm CO) or 100 ppm CO. Five levels of tapping difficulty and two levels of digit manipulation were employed. Tapping performance was unaffected when COHb levels were as high as 5%. However, at this level of COHb it was noted that CO exposure interacted with task difficulty of both tasks to influence reaction time on the digit manipulation task. It was concluded that motor performance was not influenced by exposure to CO leading to COHb concentrations of 5%. Task difficulty was a significant factor mediating behavioral effects of CO exposure.

Environmental pollution by automotive source. II. Local inhabitants's reaction to environmental pollution

Energy Technology Data Exchange (ETDEWEB)

Aizawa, R.; Hirara, K.; Izumi, T.; Mori, S.

1975-04-01

The reaction of inhabitants to auto exhaust, noise, and vibration was surveyed in commercial and residential quarters by inquiries and measurement of the carbon monoxide in expired air of the inhabitants. About 65 percent of the inhabitants of busy quarters complained of severe reactions to auto exhaust, noise, and vibration; physical effects included headache, absentmindedness, loss of appetite, prickling of eyes, pain in the throat, and frequent colds. The concentration of carbon monoxide in the expired air of inhabitants of residential quarters was about 5 ppM, and in the busy quarter with much motor traffic the concentration was about 10 ppM. The concentration of carboxyhemoglobin in blood of the latter averaged 2.5 to 2.6 percent, and the former was 1.5 percent. The data were taken among non-smokers, and there were socio-economic differences among inhabitants of both quarters.

Fetal brain damage following maternal carbon monoxide intoxication: an experimental study

Energy Technology Data Exchange (ETDEWEB)

Ginsberg, M D; Myers, R E

1974-01-01

Techniques of fetal monitoring, including fetal blood sampling in utero, were employed to study the physiological effects of acute maternal carbon monoxide intoxication on nine term-pregnant female rhesus monkeys exposed to 0.1 to 0.3% inspired carbon monoxide over 1 to 3 hr. The mothers tolerated carboxyhemoglobin levels exceeding 60% without clinical sequelae, whereas the fetuses promptly developed profound hypoxia upon exposure of the mothers to CO. The fetal COHb levels rose only gradually over 1 to 3 hr, and thus contributed only slightly to the development of early fetal hypoxia. The fetal hypoxia was associated with bradycardia, hypotension, and metabolic and respiratory acidosis. Severity of intrauterine hypoxia was closely correlated with the appearance of brain damage. Brain swelling associated with hemorrhagic necrosis of the cerebral hemispheres (severe brain damage) appeared only in fetuses whose arterial oxygen content was reduced below 1.0 ml/100 ml for at least 45 min during the maternal CO intoxication.

A technique for extracting blood samples from mice in fire toxicity tests

Science.gov (United States)

Bucci, T. J.; Hilado, C. J.; Lopez, M. T.

1976-01-01

The extraction of adequate blood samples from moribund and dead mice has been a problem because of the small quantity of blood in each animal and the short time available between the animals' death and coagulation of the blood. These difficulties are particularly critical in fire toxicity tests because removal of the test animals while observing proper safety precautions for personnel is time-consuming. Techniques for extracting blood samples from mice were evaluated, and a technique was developed to obtain up to 0.8 ml of blood from a single mouse after death. The technique involves rapid exposure and cutting of the posterior vena cava and accumulation of blood in the peritoneal space. Blood samples of 0.5 ml or more from individual mice have been consistently obtained as much as 16 minutes after apparent death. Results of carboxyhemoglobin analyses of blood appeared reproducible and consistent with carbon monoxide concentrations in the exposure chamber.

Chronic cigarette smoke exposure adversely alters 14C-arachidonic acid metabolism in rat lungs, aortas and platelets

International Nuclear Information System (INIS)

Lubawy, W.C.; Valentovic, M.A.; Atkinson, J.E.; Gairola, G.C.

1983-01-01

Male rats were exposed to freshly generated cigarette smoke once daily, 5 times a week for 10 weeks. Inhalation of smoke was verified by elevated carboxyhemoglobin in blood sampled immediately after smoke exposure and by increased lung aryl hydrocarbon hydroxylase activity 24 hours after the last smoke exposure. Aortic rings isolated from smoke-exposed rats synthesized less prostacyclin (PGI2) from 14 C-arachidonic acid than rings from sham rats. Platelets from smoke-exposed rats synthesized more thromboxane (TXA2) from 14 C-arachidonic acid than platelets from room controls but not those from sham rats. Lung microsomes from smoke-exposed rats synthesized more TXA2 and had a lower PGI2/TXA2 ratio than lung microsomes from room controls and shams. It is concluded that chronic cigarette smoke exposure alters arachidonic acid metabolism in aortas, platelets and lungs in a manner resulting in decreased PGI2 and increased TXA2, thereby creating a condition favoring platelet aggregation and a variety of cardiovascular diseases

Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation.

Science.gov (United States)

Teerapuncharoen, Krittika; Sharma, Nirmal S; Barker, Andrew B; Wille, Keith M; Diaz-Guzman, Enrique

2015-09-01

Carbon monoxide (CO) is the most common cause of poisoning and poisoning-related death in the United States. It is a tasteless and odorless poisonous gas produced from incomplete combustion of hydrocarbons, such as those produced by cars and heating systems. CO rapidly binds to hemoglobin to form carboxyhemoglobin, leading to tissue hypoxia, multiple-organ failure, and cardiovascular collapse. CO also binds to myocardial myoglobin, preventing oxidative phosphorylation in cardiac mitochondria and resulting in cardiac ischemia or stunning and cardiogenic pulmonary edema. Treatment of CO poisoning is mainly supportive, and supplemental oxygen remains the cornerstone of therapy, whereas hyperbaric oxygen therapy is considered for patients with evidence of neurological and myocardial injury. Extracorporeal membrane oxygenation (ECMO) has been utilized effectively in patients with respiratory failure and hemodynamic instability, but its use has rarely been reported in patients with CO poisoning. We report the successful use of venoarterial ECMO in a patient with severe CO poisoning and multiple-organ failure. Copyright © 2015 by Daedalus Enterprises.

Experimental model of smoking and simulation of reflux with acid and pepsin in rats.

Science.gov (United States)

Zen Junior, José Hélio; Del Negro, André; Colli Neto, José Alexandre; Araujo, Marina Rachel; Altemani, Albina Maria; Andreollo, Nelson Adami

2012-01-01

To develop experimental models to evaluate the effects of hydrochloric acid associated with the pepsin instilled in the mucosa of the upper esophagus and the esophagogastric junction of young male rats Wistar, simulating injury caused by gastroesophageal reflux on the mucosa of aero-digestive tract in humans as well as the action of the risk exposure of mucosa to cigarette smoke. Fifty young male Wistar rats divided in 5 groups with 10 animals each one, respectively simulating pharyngo-laryngeal reflux and gastroesophageal reflux, pharyngo-laryngeal reflux and smoking, smoking only, gastroesophageal reflux and control group. The histopathologic studies no recorded neoplasias, only mild changes and no significant alterations. The hemo-oximetry (carboxyhemoglobin and methemoglobim) and CO2 concentration confirm that the animals were submitted to high intensity of exposure to carcinogens in tobacco and its derivatives. The experimental models were highly efficient, practical, easy to use and economical and can be employed in other similar studies to determine the harmful effects by smoking and reflux.

Suicide by self-incineration

DEFF Research Database (Denmark)

Leth, Peter Mygind; Hardt-Madsen, Michael

1997-01-01

was 43 years, with a broad age range (20-87). Many incidents of self-incineration as a form of political protest were reported in the press especially during the 1960s and 1970s, and the press reports often inspired others to commit suicide in the same way. None of the cases in our investigation were...... victims were of Danish origin, and a religious motive played no significant role. Most of the victims were suffering from mental illness, and a majority had tried to commit suicide before. None of the victims left a suicide note. The scene was most often at home and indoors--only a minority committed...... suicide in remote areas of the countryside. Most were found dead at the scene, and the cause of death was usually heat exposure. Only a minority had a lethal carboxy-hemoglobin (CO-Hb) concentration. It is concluded that close cooperation between police, fire experts, and the forensic pathologist...

Health aspects of automotive pollutants

Energy Technology Data Exchange (ETDEWEB)

Jouan, M

1973-01-01

General health aspects of carbon monoxide, lead, nitrogen oxides, unburned hydrocarbons, and aldehydes are described. Unlike spark ignition engines, diesel engines emit but minimal quantities of carbon monoxide. Automotive carbon monoxide may cause chronic poisoning by its combination with hemoglobin. The threshold value beyond which physiological changes occur lies at 2.5 percent carboxyhemoglobin. Nitric oxide, and especially nitrogen dioxide cause pulmonary edema, impaired respiratory function, and chronic bronchitis in very low concentrations. According to regulations implemented in France, a CO concentration of 40 ppM/hr must occur not more than 1 percent of the time on a yearly basis. A level of 15 ppm must not be exceeded for more than 15 percent of the time in any 9-hour period. The maximum allowable 1-hour nitrogen oxide concentration is set at 0.25 ppM. The emission standards implemented, as well as favorable meteorological conditions have resulted in an abatement of the CO concentrations in Paris.

Content of carbon monoxide in the tissues of rats intoxicated with carbon monoxide in various conditions of acute exposure

Energy Technology Data Exchange (ETDEWEB)

Sokal, J.A.; Majka, J.; Palus, J.

1984-12-01

Tissue carbon monoxide (CO) content was investigated in rats severely intoxicated with CO under various exposure conditions: 1% CO for 4 min, 0.4% CO for 40 min and 0.12% CO for 12 h. Extravascular CO was determined in the heart and skeletal muscles immediately after termination of exposure, and carboxymyoglobin (MbCO) percent saturation was calculated. Total brain CO was estimated immediately after termination of exposure and after the time periods of restitution. After the same exposure conditions, MbCO percent saturation was higher in the heart than in skeletal muscle. In both types of muscle, saturation on myoglobin (Mb) with CO depended on blood carboxyhemoglobin (HbCO) level and not on the duration of exposure. The time course of CO elimination was the same for blood and brain, irrespective of CO exposure conditions. The results obtained showed that acute CO intoxication induced by long duration exposures did not involve CO accumulation in the tissues.

An Unusual Cause of Supraventricular Tachycardia: Acute Carbon Monoxide Poisoning

Directory of Open Access Journals (Sweden)

Suat Zengin

2014-03-01

Full Text Available      Carbon monoxide (CO is a toxic gas produced by the incomplete combustion of carbon-containing compounds. Exposure to high concentrations of CO can be letha and is the most common cause of death from poisoning worldwide. Cardiac manifestations after exposure to CO, including myocardial ischemia, heart failure, and arrhythmias, have been reported. A 28-year-old a patient was admitted to our emergency department with altered consciousness as a consequence of acute domestic exposure to CO from a stove. His carboxyhemoglobin level was 39%. The oxygen treatment was started promptly, and therapeutic red cell exchange was performed. An electrocardiogram revealed supraventricular tachycardia (SVT, and an echocardiographic examination demonstrated normal cardiac functions. To the best of our knowledge, this study is the second to report a case of SVT attack due to acute CO intoxication. This paper discusses the management of this complication in patients poisoned with CO.

Formation of cigarette smoke-induced DNA adducts in the rat lung and nasal mucosa

International Nuclear Information System (INIS)

Gupta, R.C.; Sopori, M.L.; Gairola, C.G.

1989-01-01

The formation of DNA adducts in the nasal, lung, and liver tissues of rats exposed daily to fresh smoke from a University of Kentucky reference cigarette (2R1) for up to 40 weeks was examined. The amount of smoke total particulate matter (TPM) inhaled and the blood carboxyhemoglobin (COHb) values averaged 5-5.5 mg smoke TPM/day/rat and 5.5%, respectively. The pulmonary AHH activity measured at the termination of each experiment showed an average increase of about two- to threefold in smoke-exposed groups. These observations suggested that animals effectively inhaled both gaseous and particulate phase constituents of cigarette smoke. DNAs from nasal, lung, and liver tissue were extracted and analyzed by an improved 32 P-postlabeling procedure. The data demonstrate the DNA-damaging potential of long term fresh cigarette smoke exposure and suggest the ability of the tissue to partially recover from such damage following cessation of the exposure

Survey of lead and CO--Hb in inhabitants in general

Energy Technology Data Exchange (ETDEWEB)

Mishima, M.; Hitosugi, M.; Ishikawa, K.; Suzuki, T.

1972-11-01

To grasp the effects of air pollution on the human body in smaller cities, lead content and CO--Hb (carboxyhemoglobin) in blood were examined in inhabitants of Soka City, Saitama Prefecture, as well as the factors of living. The inhabitants are nonuniform as an occupational population, however, from the point of view that the work places are located in the same city they are considered to be uniform as an occupational population. In the city, the Pb content of air was 6, 2 to 5 and 1 microgram/cu m, respectively, in highly, moderately, and slightly polluted areas. The Pb content of blood of inhabitants in highly polluted areas in the city was on the arithmetical average - 15 micrograms/dl, and CO--Hb in the same individuals was 1.8% (2.6% in smokers and 1.2% in nonsmokers). These figures mean that the effect of air pollution was very slight in the inhabitants in this city.

Subclinical carbon monoxide poisoning in our health area

Energy Technology Data Exchange (ETDEWEB)

Arroyo, I.G.; Testa, A.F.; Sangrador, C.O.; Garcia, M.T.A.; Berrocal, J.L.S.; Pastor, N.R.; Martin, J.M.; Garcia, L.S.; Garcia, M.C.F.; Maire-Richard, E.G. [Hospital of Virgen Concha, Zamora (Spain)

2003-08-01

We present an observation study on the relationship between high levels of carboxyhemoglobin (COHB) and subclinical poisoning by carbon monoxide (CO) in our health area. The study was carried out in February and March 2000 in 228 over 18-year-old patients of both sexes who went to the Emergency Room for various reasons. After an informed consent was conceded, a venous blood sample was obtained in order to determine the level of COHB; later, we collected the anthropometric data, the data relative to the tobacco use, and the data of the type of heating at home. The values limit of the COHB obtained were the following: in non smokers, 1.9%; in 1-10 cigarettes/day smokers, 5.2%; in 11-20 cigarettes/day smokers, 6.9%; in {gt}20 cigarettes/day smokers, 9.6%. A COHB high level was observed in 25% of the patients regardless of the smoking habits, being the coal-dust slack brazier the source of most frequent exposure to CO.

Acute wood or coal exposure with carbon monoxide intoxication induces sister chromatid exchange

Energy Technology Data Exchange (ETDEWEB)

Ozturk, S.; Vatansever, S.; Cefle, K.; Palanduz, S.; Guler, K.; Erten, N.; Erk, O.; Karan, M.A.; Tascioglu, C. [University of Istanbul, Istanbul (Turkey). Istanbul Faculty of Medicine

2002-07-01

The object of this study was to investigate the genotoxic effect of acute overexposure to combustion products originating from coal or wood stoves in patients presenting with acute carbon monoxide intoxication. The authors analyzed the frequency of sister chromatid exchange and the carboxyhemoglobin concentration in 20 consecutive patients without a history of smoking or drug use who had been treated in the Emergency Care Unit of Istanbul Medical Faculty due to acute carbon monoxide intoxication. All of these cases were domestic accidents due to dysfunctioning coal or wood stoves. The results were compared with a control group of 20 nonsmoking, nondrug-using healthy individuals matched for age, sex, and absence of other chemical exposure. It was concluded that acute exposure to combustion products of wood or coal is genotoxic to DNA. Potential causes of genotoxicity include known mutagenic compounds present in coal or wood smoke and ash, oxygen radicals formed during combustion, as well as hypoxic and reperfusion injury mechanisms initiated by carbon monoxide intoxication.

Measurements of regional lung water with 0-15 labeled water and CO-15 labeled carboxyhemoglobin

International Nuclear Information System (INIS)

Helmeke, H.J.; Schober, O.; Lehr, L.; Junker, D.; Meyer, G.J.; Fitschen, J.; Bossaller, C.; Hundeshagen, H.

1982-01-01

Determination of regional vascular lung water is only practicable by external imaging since it is the only method which allows analysis of many regions. 0-15 was produced by our medical cyclotron (MC-35) via the N-14(d,n)0-15 reaction and processed to H 2 O-15 as the diffusible and to CO-15-hemiglobin autologous erythrocytes - as the intravascular tracer. The activity over both lungs applied as a bolus into the right atrium (5-10 mCi/1 sec) was followed by a positron camera (4200; Cycl. Corp.). Data acquisition and analysis was done in a pdp 11-55 computer system. Mean transit times were computed by the 'height over area' and the 'ratio of moments' method. The extravascular lung water per unit of plasma volume (ELW/Vp) was calculated according to Fazio et al. (1976).The lungs were divided into six zones. 47 investigations in 27 patients were caried out (controls, patients with heart failure, and critically ill with respiratory distress). As expected critically ill patients (ELW/Vp = 0.39+-0.19/0.66+-0.21) demonstrated a higher ELW/Vp than those suffering from myocardial insufficiency (ELW/V = 0.30+-0.13) or controls (ELW/Vp = 0.22+-0.11). Various factors involved in the measurement of lung water are mentioned. Because of methodological considerations and the worse discrimination concerning of the 'ratio of moments' method we prefer the 'height over area' analysis in the determination of transit times. The scintigraphic estimation of the so defind regional lung water is possible as the discrimination of groups is; the follow up or quantification of regional lung water of a patient in clinical routine work seems to be not yet established under the demonstrated conditions. (Author)

Imbalance between production and conjugation of bilirubin: a fundamental concept in the mechanism of neonatal jaundice.

Science.gov (United States)

Kaplan, Michael; Muraca, Maurizio; Hammerman, Cathy; Rubaltelli, Firmino F; Vilei, Maria T; Vreman, Hendrik J; Stevenson, David K

2002-10-01

The objective of this study was to evaluate the roles of production and conjugation of bilirubin, individually and in combination, in the mechanism of neonatal jaundice. A cohort of healthy, term male newborns was sampled on the third day of life, coincident with routine metabolic screening, for blood carboxyhemoglobin determination, a reflection of heme catabolism, and for serum unconjugated and conjugated bilirubin fractions, reflecting bilirubin conjugation. The former was determined by gas chromatography, corrected for inspired CO (COHbc), and expressed as percentage of total hemoglobin. Serum bilirubin fractions were quantified by alkaline methanolysis and reverse phase high performance liquid chromatography. The sum of all bilirubin fractions comprised serum total bilirubin (STB). Total conjugated bilirubin (TCB) was comprised of the sum of the conjugated fractions and was expressed as percentage of STB (TCB[%]). A "bilirubin production/conjugation index" (COHbc/[TCB(%)] represented the combined roles of these modalities in the mechanism of bilirubinemia. Relationships between STB concentrations on the one hand, and COHbc values, TCB(%) proportions, and the production/conjugation index on the other, were determined by applying a best-fit regression analysis methodology. Mean (+/- standard deviation) STB concentration at the time of sampling was 114 +/- 48 micro mol/L (range: 8-263 micro mol/L). Mean COHbc value was 0.77 +/- 0.19%, and median (interquartile range) TCB(%) was 0.737 (0.465-1.260)%. COHbc values correlated directly with STB concentrations (r = 0.38; s = 46.1), and TCB(%) correlated inversely with STB (r = 0.40; s = 45.8). The production/conjugation index correlated positively with STB values (r = 0.61; s = 45.8), the r value for the index being higher than that of either COHbc or TCB(%), individually. The bilirubin production/conjugation index seemed to have a biphasic relationship to STB: STB values rose steeply in concert with increasing index

Variations of time-to-incapacitation and carboxyhemoglobin values in rats exposed to two carbon monoxide concentrations.

Science.gov (United States)

1993-05-01

It has been suggested that passenger protective breathing equipment protect aircraft passengers from smoke for 5 min during an evacuation phase and for 35 min during an in-flight-plus-evacuation phase. Carbon monoxide (CO) is one of the most abundant...

Carbon monoxide reduces near-infrared spectroscopy determined 'total' hemoglobin

DEFF Research Database (Denmark)

Niemann, Mads J; Sørensen, Henrik; Siebenmann, Christoph

2017-01-01

with CO (1.5 mL kg-1) was added to the circuit. Two NIRS systems (NIRO-200NX and INVOS-5100) assessed ScO2 as the ratio of oxygenated to deoxygenated hemoglobin, while venous blood samples were analyzed for carboxyhemoglobin (COHb). After CO/O2 rebreathing COHb increased to 8.7% (IQR; 7.9-9.4; p = .004...... to normoxia (68.9 ± 6.9%; p hemoglobin decreased (by 19.7 μM (median; IQR 2.8-34.8; p = .016) and 37.3 μM (30.8-46.6; p = .004), respectively) during inhalation of CO/O2 compared...... to inhalation of O2. Therefore, NIRO-200NX determined 'total' hemoglobin (sum of O2Hb and HHb) decreased (by 62.1 μM; 44.5-78.2; p = .001). In conclusion, exposure to CO did not increase MCAVmean, and neither NIRO-200NX nor INVOS-5100 detected a change in ScO2 when CO was added to inhalation of oxygen...

Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases.

Science.gov (United States)

Towers, Craig V; Corcoran, Vincent A

2009-03-01

The diagnosis of carbon monoxide poisoning in the third trimester of pregnancy requires an index of suspicion, and the appearance of the fetal heart monitor tracing may help in this regard. Three cases of third-trimester acute carbon monoxide poisoning occurred. In each pregnancy, the fetal heart monitor tracing on admission was correlated with the maternal carboxyhemoglobin level, and how the pattern changed following the institution of therapy was analyzed. In all 3 cases, the initial fetal heart rate pattern demonstrated decreased variability with an elevated baseline and an absence of accelerations and decelerations. Within 45-90 minutes of treatment onset, the baseline fetal heart rate dropped by 20-40 beats per minute, the variability became moderate, and accelerations occurred. Absent accelerations with minimal variability, if caused by uteroplacental insufficiency, are usually preceded by recurrent decelerations. Absent accelerations with minimal variability in the absence of recurrent decelerations may suggest another cause, of which carbon monoxide intoxication can be added to the differential, especially since this disorder often has nonspecific clinical symptoms.

Tobacco experimental model to induce urinary bladder neoplasms

Directory of Open Access Journals (Sweden)

José Alexandre Colli Neto

2014-01-01

Full Text Available OBJECTIVE: to develop an experimental model of exposure to tobacco burning (cigarette products to assess the effects of its chronic use in relation to cancers of the bladder. METHODS: the animals were chronically exposed to the burning tobacco products in a semi-open chamber to simulate smoking. Thirty young Wistar rats were divided into two groups: one with 20 animals simulating smoking for six months, and ten not exposed control animals for the same period. After exposure by inhalation of cigarette smoke, animals were euthanized and subjected to histopathological study of the bladder wall. RESULTS: no tumor was found but mild and non significant alterations. The studies of hemo-oximetry (carboxyhemoglobin and methemoglobin and the concentration of carbon dioxide (CO2 confirm that the animals were exposed to high concentrations of tobacco smoke and its derivatives. CONCLUSION: no bladder mucosal neoplasia was found in the pathological study of animals. The developed experimental models were highly efficient, practical and easy to use and can be used in other similar studies to determine the harmful effects caused by smoking.

The Effect of Swimming Activity on Lung Function Parameters Among Smoking and Non-Smoking Youth – Research Extended

Directory of Open Access Journals (Sweden)

Michalak Katarzyna

2015-12-01

Full Text Available Purpose. The purpose of this study was to evaluate the effect of regular swimming activity on the respiratory system of smokers and non-smokers. Methods. The study included 196 students, aged 19 to 24 years, attending weekly swimming classes. All students underwent pulmonary function testing before and after participating in a swimming program for 10 months. Measurements included forced vital capacity (FVC, forced expiratory volume in one second (FEV1, and peak expiratory flow (PEF. Maximal inspiratory and expiratory pressure at the mouth (PImax, PEmax and the percentage carboxyhemoglobin level in blood (%CoHb were also measured. Results. After 10 months of regular swimming activity the values of FVC, PEF, MIP and MEP increased in the non-smoking as well as in the smoking group, while the FEV1 increased only among smokers. The percentage of CoHB level in the blood decreased in both groups. Conclusions. The study confirmed the positive effect of swimming on respiratory system function and the importance of promoting physical activity such as swimming among cigarette smokers as well as non-smokers.

Comparative effects of atmospheric pollution and cigarette smoking on carboxyhaemoglobin levels in man

Energy Technology Data Exchange (ETDEWEB)

Cole, P.V.

1975-06-26

The effects of atmospheric pollution and cigarette smoking on carboxyhemoglobin levels in man were investigated in subjects living on the Island of Sark and in two areas of the City of London. The average concentration of CO on Sark is 1 ppM. A total of 78 non-smoking subjects have a mean COHb of 0.68 percent with a range of 0.2-2.6 percent. In a hospital outpatient department in the City of London (where smoking is forbidden) the ambient CO concentrations range between 2-4 ppM. The mean COHb level in 120 non-smokers is 0.97 percent with a range of 0.2-2.5 percent. In an adjacent office where smoking is permitted, the ambient concentration is slightly higher, 3-8 ppM CO. The COHb levels in 100 office workers (non-smokers) are slightly higher, a mean of 1.12 percent with a range of 0.1-2.7 percent. The mean COHb of smokers is 5.5 percent with a range of 2.2-13.0 percent.

Bronchial hyperreactivity and arterial carboxyhemoglobin as detectors of air pollution in Milan: a study on normal subjects

Energy Technology Data Exchange (ETDEWEB)

Clini, V.; Pozzi, G.; Ferrara, A.

1985-01-01

Research has been carried out in the town area of Milan on 275 subjects. For each patient the following data have been measured: ventilatory profile, aspecific bronchial reactivity, arterial concentration in CO and acid-base balance. The results obtained have been divided into four groups, according to the level of SO/sub 2/ in the area of residence of the subjects, who have also been studied with reference to the habit of smoking. The data obtained have shown (1) an alteration of the ventilatory function, with decrease of oxygen tension in arterial blood in all subjects. (2) Increase of bronchial irritability and CO concentration in arterial blood have been found in these subjects. (3) The division of the results according to the level of SO/sub 2/ pollution in the areas of residence of the patients showed the presence, in the most polluted areas of Milan (NE and SW), of higher levels of bronchial irritability and higher CO rates in arterial blood. (4) Cigarette smoking does not seem to play a major role in causing bronchial irritability. It certainly increases CO concentration: smokers have HbCO concentration higher than nonsmokers in all four areas. (5) Air pollution is more important than cigarette smoking in determining CO saturation of blood. Nonsmokers living in the most polluted areas of Milan (NE) show a higher concentration of CO in arterial blood than smokers living in the less polluted areas (SW).

Cigarette smoke exposure alters [14C]arachidonic acid metabolism in aortas and platelets of rats fed various levels of selenium and vitamin E

International Nuclear Information System (INIS)

Valentovic, M.A.; Gairola, C.; Lubawy, W.C.

1985-01-01

Rats were placed on a basal diet supplemented with 0, 0.03, or 3 ppm selenium and 0 or 20 ppm vitamin E for 41-43 wk. Selenium deficiency decreased hepatic glutathione peroxidase activity and lowered both aortic prostacyclin (PGI2) and platelet thromboxane (TXA2) production compared to selenium- and vitamin E-supplemented animals. Vitamin E deficiency increased hepatic lipid peroxidation and decreased aortic PGI2 synthesis. Rats exposed daily for 31-32 wk to fresh smoke from a UK 2R1 reference cigarette had carboxyhemoglobin levels of 0.75 +/- 0.12 and 4.73 +/- 0.12% in sham- and smoke-exposed groups, respectively. Animals chronically exposed to cigarette smoke displayed a nearly twofold increase in pulmonary arylhydrocarbon hydroxylase activity. Smoke exposure produced a 26-33% decrease in aortic PGI2 synthesis compared to shams in the Se3E20, Se0.03E20, and Se3E0 groups. Smoking also increased platelet thromboxane 91% and 98% in the Se3E20 and Se3E0 groups compared to shams. It is concluded that cigarette-smoke exposure and selenium or vitamin E deficiency alter aortic PGI2 and platelet TXA2 production

Effects of varying marijuana potency on deposition of tar and delta9-THC in the lung during smoking.

Science.gov (United States)

Matthias, P; Tashkin, D P; Marques-Magallanes, J A; Wilkins, J N; Simmons, M S

1997-12-01

To determine whether smoking more, compared to less, potent marijuana (MJ) cigarettes to a desired level of intoxication ("high") reduces pulmonary exposure to noxious smoke components, in 10 habitual smokers of MJ, we measured respiratory delivery and deposition of tar and delta9-tetrahydrocannabinol (THC), carboxyhemoglobin (COHb) boost, smoking topography, including cumulative puff volume (CPV) and breathholding time, change in heart rate (deltaHR) and "high" during ad lib smoking of 0, 1.77, and 3.95% MJ cigarettes on 3 separate days. At each session, subjects had access to only a single MJ cigarette. On average, smoking topography and COHb boost did not differ across the different strengths of MJ, while THC delivery, as well as HR, were significantly greater (p studies using a standardized smoking technique revealed a mean 25% lower tar yield from 3.95% than 1.77% MJ (p marijuana. Under the conditions of this study, we conclude that tar delivery is reduced relative to THC content in a minority of subjects, and this reduction appears to be due to a reduced intake of smoke (decreased CPV) and/or a reduced tar yield from the stronger MJ preparation.

Carbon monoxide poisoning from waterpipe smoking: a retrospective cohort study.

Science.gov (United States)

Eichhorn, Lars; Michaelis, Dirk; Kemmerer, Michael; Jüttner, Björn; Tetzlaff, Kay

2018-04-01

Waterpipe smoking may increasingly account for unintentional carbon monoxide poisoning, a serious health hazard with high morbidity and mortality. We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large critical care database of a specialty care referral center. This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical symptoms compatible with CO poisoning admitted between January 2013 and December 2016. Patients' initial symptoms and carbon monoxide blood levels were retrieved from records and neurologic status was assessed before and after hyperbaric oxygen treatment. Sixty-one subjects with carbon monoxide poisoning were included [41 males, 20 females; mean age 23 (SD ± 6) years; range 13-45] with an initial mean carboxyhemoglobin of 26.93% (SD ± 9.72). Most common symptoms included syncope, dizziness, headache, and nausea; 75% had temporary syncope. Symptoms were not closely associated with blood COHb levels. CO poisoning after waterpipe smoking may present in young adults with a wide variability of symptoms from none to unconsciousness. Therefore diagnosis should be suspected even in the absence of symptoms.

Kinetics of the fixation of carbon monoxide in the blood. III. Dose received and dose retained: significance of pollution peaks

Energy Technology Data Exchange (ETDEWEB)

Chovin, P.

1974-01-01

The kinetics of the retention of carbon monoxide in the blood is discussed with respect to certain CO concentration standards. The ratio of the amount of CO retained by the blood to the amount inhaled is independent of the CO concentration in the inhaled air and increases with decreasing exposure time. An exposure to 50 ppM CO for 8 hr causes a carboxyhemoglobin level of 5.5 percent, corresponding to a retention rate of 31.5 percent, while exposure to the same concentration for 30 min results in a retention rate of 55 percent. With the dose inhaled being constant, the COHb level varies as a function of time, increasing with shortening of the exposure time, which emphasizes the hazards of high CO peaks in street air. Exposure to 40 ppM CO for 1 hr and to 10 ppM CO for 12 hr according to the California standard will result increases in the COHb level by 0.93 percent and 1.3 percent, respectively. The inconsistency of U.S. standards is further demonstrated by the great divergence between the safety factors calculated for exposure to the maximum allowable concentrations for the respective maximum allowable durations.

Medical and social characteristics of persons with adverse cardiometabolic risk profile

Directory of Open Access Journals (Sweden)

2012-12-01

Full Text Available The study evaluated the effectiveness of screening tests performed on the basis of functioning centers of Health, to identify individuals with cardiometabolic risk factors. Materials and methods: A total of 2007 men (mean age 50,80±16,54 years were evaluated. The results of physical and psychological tests, express-analysis of functional state of heart via ECG, express-analysis of cholesterol and glucose blood levels, vascular screening, and concentration of carbon monoxide, carboxyhemoglobin and human body composition by bioimpedance were estimated. Results: During the screening we revealed 62.33% men with BMI≥25 kg/m2. BMI≥25 kg/m2 was associated with an increase in the average levels of cholesterol, fasting blood glucose, blood pressure, as well as signs of myocardial electrical instability and autonomic dysfunction. Progressive increase in BMI≥25 kg/m2 was associated with the presence of combined cardiometabolic risk factors and the presence of unhealthy lifestyle behaviors. All patients with a BMI≥25 kg/m2 received individual recommendations about a mode of work, physical activity and diet, and were also invited for group training in «Weight reduction school»

Relationship between zinc protoporphyrin (ZPP) and free erythrocyte protoporphyrin (FEP) in lead-exposed individuals

Energy Technology Data Exchange (ETDEWEB)

Karacic, V.; Pripic-Majic, D.; Telis, S.

1980-11-01

The relationship between zinc protoporphyrin (ZPP) and total erythrozyte protoporphyrin, measured as free erythrozyte protoporphyrin (FEP), was determined in 194 adult subjects with different occupational and non-occupational lead exposures. Furthermore, the ZPP-FEP comparison was considered with respect to the dose-effect relationship of ZPP and FEP with blood lead (PbB) for males and females, Bilirubin (Bil.) interferences in ZPP analysis were taken into account. A very close and highly significant relationship was established between ZPP and FEP values. A significant correlation between log ZPP or log FEP and PbB was also found. It was established, by both in vitro and in vivo studies, that Bil. interferes with the ZPP fluorescence readings; the relationship between false positive ZPP concentrations and Bil. concentrations was highly significant. A small but highly significant influence of increased carboxyhemoglobin (COHb) concentrations on the decrease in hermatofluorometer ZPP readings, due to inadequate oxygenation of the blood, was found. The results obtained confirm the usefulness of ZPP determinations using hematofluorometers for surveillance of increased lead absorption but stress that the interfering effect of Bil. and to a lesser extent of COHb, cannot be ignored.

Experimental and clinical study of chronic poisoning by carbon monoxide

Energy Technology Data Exchange (ETDEWEB)

Thiele, H.; Gohlke, R.; Rothe, R.

1973-01-01

Animal and clinical tests on carbon monoxide-exposed subjects are described in an attempt to demonstrate the specific chronic action of CO. Rabbits exposed to 802 ppM and 284 ppM CO for 103 and 112 days, respectively, for 5 days a week showed carboxyhemoglobin values in the respective ranges of 2.5 to 11.9% and 2.5 to 8.3%. The macroscopic findings and gain in weight were normal, except for an increase by 20% and 14% in the weight of the liver. Dose-dependent increases in the hemoglobin and hematocrit levels, significant increases in the pyruvate level of the first group, and significant reductions of the cholinesterase, inorganic phosphate levels, hepatic lipase, phosphate, phosphatase, and cytochrome-C oxidase were observed. An increased cholinesterase level was found in brain homogenates. Inhibition of the glucose-6-phosphatase was observed. There is a specific damage due to CO in addition to merely the hypoxic effect. Clinical tests in humans with and without acute, subacute, or chronic exposure to CO revealed that acute and subacute poisoning have no additional pathogenic effect in chronic exposure, i.e., indicate the existence of primary chronic poisoning with CO.

Results of investigation concerning labor hygiene of the workers in the charge collecting offices of speedways

Energy Technology Data Exchange (ETDEWEB)

Tomita, K.; Nakana, S.; Horiuchi, L.; Horiguchi, S.; Husunomiya, T.; Shinagawa, K.; Teramoto, K.; Fujii, T.

1973-01-01

An industrial hygienic investigation was carried out for 3 days in March 1971 on toll-collectors. The effect of their environmental conditions, such as concentration of lead, (carbon monoxide) floating dust, and oxides of nitrogen on subjective symptoms, hematology, urine, sputum, amount of carbon monoxide in expired air lung function, and blood chemistry. The atmospheric content of lead during the 3 days was less than 4 micrograms/cu m except for two peaks of 7 and 12 micrograms/cu m. The level of CO 1 to 5.5 ppM, nitrogen dioxide was 0.5 to 0.30 ppM, and sulfur dioxide was 1 to 0.06 ppM. The large amount of floating dusts was due to truck exhaust. The average concentrations of CO in expired air and carboxyhemoglobin of 22 smokers and seven non-smokers were respectively 24.6 + or - 5.5 ppM, 12.9 + or - 2.3 ppM, and 5.7 + or - 0.9, and 2.8 + or - 0.5 volume percent. The vital capacity, VCsec, and Vsec were, respectively, on the average, 3785 + or - 493, 3272 + or - 452, and 87 + or - 5 in 17 smokers.

Idiopathic erythrocytosis in a patient on chronic hemodialysis

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Dong Hyun Lee

2015-03-01

Full Text Available A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7–31.5 mIU/mL, carboxyhemoglobin level was 0.6% (range, 0–1.5%, and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.

Toxicity of carbon monoxide hydrogen cyanide gas mixtures : exposure concentration, time to incapacitation, carboxyhemoglobin and blood cyanide parameters.

Science.gov (United States)

1994-04-01

During aircraft interior fires, carbon monoxide (CO) and hydrogen cyanide (HCN) are produced in sufficient amounts to cause incapacitation and death. Time-to-incapacitation (ti) is a practical parameter for estimating escape time in fire environments...

Policemen exposure to atmospheric pollutants in Paris; Exposition des policiers aux polluants atmospheriques a Paris

Energy Technology Data Exchange (ETDEWEB)

Bugajny, Ch.; Coursimault, A.; Donati, J.; Vieillard, H. [Laboratoire Central de la Prefecture de Police de Paris, 75 (France); Ducos, P.; Gaudin, R. [Institut National de Recherche et de Securite, 54 - Vandoeuvre les Nancy (France)

2000-07-01

The objective of this study was to evaluate the effects of automotive pollution on police health in Paris, more particularly those that are working near streets and crossroads; police working indoors are included in measurements as a reference population. This work included individual exposure measurements to some urban pollution main indicators and biological determinations to estimate the impact of these pollutants on health. Biological measurements, including determinations of carboxyhemoglobin, lead in blood and trans, trans-muconic acid in urine were realised. Carbon monoxide and benzene individual exposure had been measured by the use of individual analysers and diffusive samplers respectively. Motorcycle policemen and policemen at crossroads are more exposed than reference population working indoor. CO mean exposure levels are 6, 8 mg/m{sup 3} for motorcycle policemen, 5, 4 mg/m{sup 3} for policemen at crossroads, compared to 3, 6 mg/m{sup 3} for policemen working indoors. Carboxyhemoglobin mean values before work are four to five times more important for smokers (4, 5 % HbCO) than no-smokers (1,0%HbCO). After work, these values are respectively 5,3 % and 1,1 %. Non-smokers agents don't reach the OMS value (2,5%HbCO), even after work. Smoking contributes to higher levels of CO in blood than car exhaust pollutants, even for high air pollutants concentrations. Lead blond levels, which average is 45{mu}g/l, are clearly smaller than the OMS value (200{mu}g/l). About non-smokers agents, benzene median exposures are 74 {mu}g/m{sup 3} for motorcycle policemen, 19 {mu}g/m{sup 3} for policemen at crossroads, compared to 8 {mu}g/m{sup 3} for sedentary agents. If motorcycle agents filled up the tank with gasoline, benzene median exposure level is 229 {mu}g/m{sup 3}. Differences between smokers and non-smokers benzene exposure are not significant. For non-smokers agents, median trans, trans muconic acid values after work are 0,06 mg/l for pollution exposed agents

Estimation of perimortal percent carboxy-heme in nonstandard postmortem specimens using analysis of carbon monoxide by GC/MS and iron by flame atomic absorption spectrophotometry.

Science.gov (United States)

Middleberg, R A; Easterling, D E; Zelonis, S F; Rieders, F; Rieders, M F

1993-01-01

In decomposed, formalin-fixed, embalmed, exhumed, and some fire-dried cases in which normal blood is unavailable, the usual methods for determination of carboxyhemoglobin saturation frequently fail. To address these specimens, a method utilizing both gas chromatography/mass spectrometric (GC/MS) determination of carbon monoxide (CO) and flame atomic absorption spectrophotometry (FAAS) determination of iron (Fe), in the same specimen, was developed. The method is reported here, along with its application to seven pertinent forsensic death investigations. The CO analytical methodology involves acid liberation of the gas from the specimen aliquot in a headspace vial. After heating and equilibrating, a sample of the headspace vapor is injected into the GC/MS system with a gastight syringe. Quantitation is achieved by standard addition comparison utilizing the ideal gas law equation. Iron is quantified by FAAS analysis of the same aliquot used for the CO determination, following nitric acid digestion. The concentration is determined by comparison to a standard curve. A formula for determining the minimum percent carboxy-heme saturation was derived by using the ratio of the amount of CO to the amount of Fe in the aliquot analyzed. Tissue types analyzed include spleen, liver, muscle, dried blood, and unspecified decomposed tissue.

Variability in hyperbaric oxygen treatment for acute carbon monoxide poisoning.

Science.gov (United States)

Byrne, Brendan T; Lu, Jenny J; Valento, Matthew; Bryant, Sean M

2012-01-01

In patients with acute carbon monoxide (CO) poisoning, we have noted wide clinical variability in both criteria for hyperbaric oxygen (HBO2) treatment as well as HBO2 treatment regimens. Our aim was to survey Midwest hyperbaric centers for insight into specific criteria and protocols for treating acute CO toxicity with HBO2. Hyperbaric centers were identified from the published list of the Undersea and Hyperbaric Medical Society. Ninety-three centers from nine Midwestern states were contacted via telephone. A standard script was used to minimize surveyor bias. Thirty centers that treat CO poisonings were identified. One did not participate in the study. Nineteen reported a specific level of carboxyhemoglobin (COHb) that served as an independent indication for initiation of HBO2 treatment. Four centers used the COHb level as the exclusive indication for HBO2 treatment. Ten centers relied solely on reported symptoms, while the remaining centers used a combination of symptoms plus COHb levels. There were 19 separate treatment protocols. No uniform practice for either the initiation or implementation of HBO2 therapy for CO poisoning exists among U.S. Midwest hyperbaric centers responding to a survey. We see opportunity for specific targeted educational programs as well as further study.

Selection criteria utilized for hyperbaric oxygen treatment of carbon monoxide poisoning.

Science.gov (United States)

Hampson, N B; Dunford, R G; Kramer, C C; Norkool, D M

1995-01-01

Medical directors of North American hyperbaric oxygen (HBO) facilities were surveyed to assess selection criteria applied for treatment of acute carbon monoxide (CO) poisoning within the hyperbaric medicine community. Responses were received from 85% of the 208 facilities in the United States and Canada. Among responders, 89 monoplace and 58 multiplace chamber facilities treat acute CO poisoning, managing a total of 2,636 patients in 1992. A significant majority of facilities treat CO-exposed patients with coma (98%), transient loss of consciousness (LOC) (77%), ischemic changes on electrocardiogram (91%), focal neurologic deficits (94%), or abnormal psychometric testing (91%), regardless of carboxyhemoglobin (COHb) level. Although 92% would use HBO for a patient presenting with headache, nausea, and COHb 40%, only 62% of facilities utilize a specified minimum COHb level as the sole criterion for HBO therapy of an asymptomatic patient. When COHb is used as an independent criterion to determine HBO treatment, the level utilized varies widely between institutions. Half of responding facilities place limits on the delay to treatment for patients with only transient LOC. Time limits are applied less often in cases with persistent neurologic deficits. While variability exists, majority opinions can be derived for many patient selection criteria regarding the use of HBO in acute CO poisoning.

Multiwavelength pulse oximetry in the measurement of hemoglobin fractions

Science.gov (United States)

Manzke, Bernd; Schwider, Johannes; Lutter, Norbert O.; Engelhardt, Kai; Stork, Wilhelm

1996-04-01

The two wavelength design of the majority of pulse oximeters assumes only two absorbing hemoglobin fractions, oxyhemoglobin (O2Hb), and reduced hemoglobin (HHb) irrespective of the presence of methemoglobin (MetHb) and carboxyhemoglobin (COHb). If MetHb or COHb is present, it contributes to the pulse-added absorbance signal and will be interpreted as either HHb or O2Hb or some combination of the two. In this paper we describe a noninvasive multi-wavelength pulse oximeter measuring O2Hb, HHb, MetHb, and COHb at a specified accuracy of 1.0%. The system was designed with respect to the results of numerical simulations. It consists of 9 laserdiodes (LDs) and 7 light emitting diodes (LEDs), a 16-bit analog-digital converter (ADC) and has a sampling rate of 16 kHz. The laser didoes and LEDs were coupled into multi-mode fibers and led with a liquid lightguide to the finger clip and then the photodiode. It also presents the results of a clinical study, including a setup with a quartz tungsten halogen lamp (with fiber output) and a diode array spectrometer, a standard pulse oximeter and two in-vitro oximeters (radiometer OSM3 and radiometer ABL 520) as references.

[Evaluation of a new blood gas analysis system: RapidPoint 500(®)].

Science.gov (United States)

Nicolas, Thierry; Cabrolier, Nadège; Bardonnet, Karine; Davani, Siamak

2013-01-01

We present here evaluation of a new blood gas analysis system, RapidPoint 500(®) (Siemens Healthcare Diagnostics). The aim of this research was to compare the ergonomics and analytical performances of this analyser with those of the RapidLab 1265 for the following parameters: pH, partial oxygen pressure, partial carbon dioxide pressure, sodium, potassium, ionized calcium, lactate and the CO-oximetry parameters: hemoglobin, oxyhemoglobin, carboxyhemoglobin, methemoglobin, reduced hemoglobin, neonatal bilirubin; as well as with the Dimension Vista 500 results for chloride and glucose. The Valtec protocol, recommended by the French Society of Clinical Biology (SFBC), was used to analyze the study results. The experiment was carried out over a period of one month in the Department of medical biochemistry. One hundred sixty five samples from adult patients admitted to the ER or hospitalized in intensive care were tested. The RapidPoint 500(®) was highly satisfactory from an ergonomic point of view. Intra-and inter- assay coefficients of variation (CV) with the three control levels were below those recommended by the SFBC for all parameters, and the comparative study gave coefficients of determination higher than 0.91. Taken together, the RapidPoint 500(®) appears fully satisfactory in terms of ergonomics and analytical performance.

Gene expression in rat striatum following carbon monoxide poisoning

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Shuichi Hara

2017-06-01

Full Text Available Carbon monoxide (CO poisoning causes brain damage, which is attenuated by treatment with hydrogen [1,2], a scavenger selective to hydroxyl radical (·≡OH [3]. This suggests a role of ·≡OH in brain damage due to CO poisoning. Studies have shown strong enhancement of ·≡OH production in rat striatum by severe CO poisoning with a blood carboxyhemoglobin (COHb level >70% due to 3000 ppm CO, but not less severe CO poisoning with a blood COHb level at approximately 50% due to 1000 ppm CO [4]. Interestingly, 5% O2 causes hypoxia comparable with that by 3000 ppm CO and produces much less •OH than 3000 ppm CO does [4]. In addition, cAMP production in parallel with ·≡OH production [5] might contribute to ·≡OH production [6]. It is likely that mechanisms other than hypoxia contribute to brain damage due to CO poisoning [7]. To search for the mechanisms, we examined the effects of 1000 ppm CO, 3000 ppm CO and 5% O2 on gene expression in rat striatum. All array data have been deposited in the Gene Expression Omnibus (GEO database under accession number GSE94780.

A Randomized Controlled Trial of Puncturing and Bloodletting at Twelve Hand Jing Points to Treat Acute Carbon Monoxide Poisoning as Adjunct to First Aid Treatment: A Study Protocol

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Ying Yue

2015-01-01

Full Text Available Background. Acute carbon monoxide poisoning (ACOP is a significant cause of morbidity and mortality in many countries. Twelve Hand Jing Points (THJP have been believed to be effective to treat all kinds of emergency calls in traditional Chinese medicine (TCM for more than 3000 years. This randomized controlled trial (RCT is designed to evaluate the effectiveness of THJP in curing acute carbon monoxide poisoning in first aid treatment. This paper reports the protocol of the trial. Methods/Design. This RCT is a multicenter, randomized, controlled study undergoing in China. The compliant patients are divided into the bloodletting group and standard of care group. With first aid treatments given to both of the groups, the bloodletting group is bleeding at THJP upon being hospitalized. Primary outcomes and secondary outcomes will be measured and compared between these two groups. Before treatment, immediately after treatment, and 30 minutes, 1 hour, and 4 hours after treatment, patients’ basic vital signs and state of consciousness were observed. Before treatment and 1 and 4 hours after treatment, carboxyhemoglobin concentration in venous blood samples was detected. Discussion. The objective of this study is to provide convincing evidence to clarify the efficacy and safety of THJP for early treatment of acute carbon monoxide poisoning.

Effects of chronic carbon monoxide exposure on fetal growth and development in mice

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Venditti Carolina C

2011-12-01

Full Text Available Abstract Background Carbon monoxide (CO is produced endogenously, and can also be acquired from many exogenous sources: ie. cigarette smoking, automobile exhaust. Although toxic at high levels, low level production or exposure lends to normal physiologic functions: smooth muscle cell relaxation, control of vascular tone, platelet aggregation, anti- inflammatory and anti-apoptotic events. In pregnancy, it is unclear at what level maternal CO exposure becomes toxic to the fetus. In this study, we hypothesized that CO would be embryotoxic, and we sought to determine at what level of chronic CO exposure in pregnancy embryo/fetotoxic effects are observed. Methods Pregnant CD1 mice were exposed to continuous levels of CO (0 to 400 ppm from conception to gestation day 17. The effect on fetal/placental growth and development, and fetal/maternal CO concentrations were determined. Results Maternal and fetal CO blood concentrations ranged from 1.12- 15.6 percent carboxyhemoglobin (%COHb and 1.0- 28.6%COHb, respectively. No significant difference was observed in placental histological morphology or in placental mass with any CO exposure. At 400 ppm CO vs. control, decreased litter size and fetal mass (p Conclusions Exposure to levels at or below 300 ppm CO throughout pregnancy has little demonstrable effect on fetal growth and development in the mouse.

Optical sensor technology for a noninvasive continuous monitoring of blood components

Science.gov (United States)

Kraitl, Jens; Timm, Ulrich; Lewis, Elfed; Ewald, Hartmut

2010-02-01

NIR-spectroscopy and Photoplethysmography (PPG) is used for a measurement of blood components. The absorptioncoefficient of blood differs at different wavelengths. This fact is used to calculate the optical absorbability characteristics of blood which is yielding information about blood components like hemoglobin (Hb), carboxyhemoglobin (CoHb) and arterial oxygen saturation (SpO2). The measured PPG time signals and the ratio between the peak to peak pulse amplitudes are used for a measurement of these parameters. Hemoglobin is the main component of red blood cells. The primary function of Hb is the transport of oxygen from the lungs to the tissue and carbon dioxide back to the lungs. The Hb concentration in human blood is an important parameter in evaluating the physiological status of an individual and an essential parameter in every blood count. Currently, invasive methods are used to measure the Hb concentration, whereby blood is taken from the patient and subsequently analyzed. Apart from the discomfort of drawing blood samples, an added disadvantage of this method is the delay between the blood collection and its analysis, which does not allow real time patient monitoring in critical situations. A noninvasive method allows pain free continuous on-line patient monitoring with minimum risk of infection and facilitates real time data monitoring allowing immediate clinical reaction to the measured data.

Cigarette smoking decreases dynamic inspiratory capacity during maximal exercise in patients with type 2 diabetes.

Science.gov (United States)

Kitahara, Yoshihiro; Hattori, Noboru; Yokoyama, Akihito; Yamane, Kiminori; Sekikawa, Kiyokazu; Inamizu, Tsutomu; Kohno, Nobuoki

2012-06-01

To investigate the influence of cigarette smoking on exercise capacity, respiratory responses and dynamic changes in lung volume during exercise in patients with type 2 diabetes. Forty-one men with type, 2 diabetes without cardiopulmonary disease were recruited and divided into 28 non-current smokers and 13 current smokers. All subjects received lung function tests and cardiopulmonary exercise testing using tracings of the flow-volume loop. Exercise capacity was compared using the percentage of predicted oxygen uptake at maximal workload (%VO2max). Respiratory variables and inspiratory capacity (IC) were compared between the two groups at rest and at 20%, 40%, 60%, 80% and 100% of maximum workload. Although there was no significant difference in lung function tests between the two groups, venous carboxyhemoglobin (CO-Hb) levels were significantly higher in current smokers. %VO2max was inversely correlated with CO-Hb levels. Changing patterns in respiratory rate, respiratory equivalent and IC were significantly different between the two groups. Current smokers had rapid breathing, a greater respiratory equivalent and a limited increase in IC during exercise. Cigarette smoking diminishes the increase in dynamic IC in patients with type 2 diabetes. As this effect of smoking on dynamic changes in lung volume will exacerbate dynamic hyperinflation in cases complicated by chronic obstructive pulmonary disease, physicians should consider smoking habits and lung function when evaluating exercise capacity in patients with type 2 diabetes.

Suicidal inhalation of motorbike exhaust: adding new data to the literature about the contribution of gasoline in the cause of death.

Science.gov (United States)

Martínez, María A; Ballesteros, Salomé

2006-01-01

We would like to alert toxicologists to the importance of testing for gasoline, and for volatile hydrocarbons in general, in deaths involving inhalation of exhaust fumes occurring in closed spaces with running motors or machinery. We present here a case of suicidal inhalation of motorbike exhaust, a mixture of carbon monoxide (CO) and gasoline vapor, by a 38-year-old female. She was found in her closed home garage with a hose extending from the exhaust pipe of a motorbike through a cellophane plastic device into a closed tent in which the victim lay. She left two suicide notes nearby. The carboxyhemoglobin (COHb) was measured using visible spectrophotometry. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame-ionization detector and confirmation was performed using gas chromatography-mass spectrometry. The %COHb determined in blood was 73%. Gasoline concentrations in heart blood and vitreous humor were 22.3 and 1.0 mg/L, respectively. Although fatalities with CO at this rate are common, we would like to highlight the role of gasoline and add new quantitative data of this toxic substance to the scarce literature. Based upon the toxicological data, along with the information provided by the medical examiner, the cause of death was determined to be CO and gasoline poisoning and the manner of death suicide.

A study on structural changes in protein by time-division type Laue method

International Nuclear Information System (INIS)

Morimoto, Hideki

1995-01-01

In order to know the physiological roles of proteins, it is important to investigate the intermediate states of their structural changes. The sizes of proteins are generally several tens angstrom(A). Considering the resolution, only x-ray crystal analysis can be used in practice for the investigation of the mechanism of protein structural changes, though NMR is applicable only for small-sized proteins. However, x-ray analysis is not so suitable for analysis of their intermediate states. Thus, the author paid attention to the time-division type Laue method for the study of hemoglobin (Hb). Laser-flash induces to release carbonmonooxide (CO) from carboxyhemoglobin (Hb(CO) 4 ). Therefore, if an appropriate length of x-ray pulse (∼100 picosec) is available, the processes in the period from cleavage of the bond between a ligand (O 2 , CO or NO) and Hb to recombination of them might be monitored. Using DNA recombination and chemical modification techniques, recombinant Hb, of which T structure is stable was produced. An investigation on the conditions which allow to release CO from the Hb is undertaken using a single crystal of this Hb. The experimental systems applicable to time-division type Laue method are some protein molecules participating in chemical reactions inducible by light absorption, the electron-transfer system excited by light and so on. (M.N.)

Requests for emergency hyperbaric oxygen treatment for carbon monoxide poisoning in Ankara, Turkey.

Science.gov (United States)

Özgök-Kangal, Münïre Kübra; Karatop-Cesur, Iclal; Akcali, Gökhan; Yildiz, Senol; Uzun, Günalp

2016-09-01

Carbon monoxide (CO) poisoning is common in Turkey. Our department is the main provider of emergency hyperbaric oxygen therapy (HBOT) in Ankara and neighboring cities. In this study, we analyzed the characteristics of CO-poisoned patients who were referred by phone to our department for emergency HBOT. We retrospectively reviewed the records of phone consultations with emergency departments regarding the need for treatment of CO-poisoned patients with HBOT between 14 January 2014 and 14 January 2015. The following information was extracted from medical records: age, gender, CO source, exposure duration, carboxyhemoglobin (COHb) level, symptoms, electrocardiography (ECG) findings, cardiac enzymes, pregnancy, the distance of referring hospital to our centre, time between admission and consultation and HBOT decision. Over the one-year period, 562 patients with CO poisoning were referred for HBOT. We recommended HBOT for 289 (51%) patients. HBOT was recommended for 58% (n = 194) of the patients with COHb ≥ 25%, 72% (n = 163) of the patients with a history of syncope, 67% (n = 35) of the patients with ECG abnormality, and 67% (n = 14) of pregnant patients. Patients for whom HBOT was not recommended despite having positive signs of severe poisoning were referred significantly later compared to patients for whom HBOT was recommended. We found that the duration from admission to an emergency department to HBOT consultation affected our decision-making.

Indoor pollutant levels from the use of unvented natural gas fireplaces in Boulder, Colorado.

Science.gov (United States)

Dutton, S J; Hannigan, M P; Miller, S L

2001-12-01

High CO and NO2 concentrations have been documented in homes with unvented combustion appliances, such as natural gas fireplaces. In addition, polycyclic aromatic hydrocarbons (PAH) are emitted from incomplete natural gas combustion. The acute health risks of CO and NO2 exposure have been well established for the general population and for certain high-risk groups, including infants, the elderly, and people with heart disease or asthma. Health effects from PAH exposure are less well known, but may include increased risk of cancer. We monitored CO emissions during the operation of unvented natural gas fireplaces in two residences in Boulder, CO, at various times between 1997 and 2000. During 1999, we expanded our tests to include measurements of NO2 and PAH. Results show significant pollutant accumulation indoors when the fireplaces were used for extended periods of time. In one case, CO concentrations greater than 100 ppm accumulated in under 2 hr of operation; a person at rest exposed for 10 hr to this environment would get a mild case of CO poisoning with an estimated 10% carboxyhemoglobin level. Appreciable NO2 concentrations were also detected, with a 4-hr time average reaching 0.36 ppm. Similar time-average total PAH concentrations reached 35 ng/m3. The results of this study provide preliminary insights to potential indoor air quality problems in homes operating unvented natural gas fireplaces in Boulder.

Point-of-care hemoglobin testing for postmortem diagnosis of anemia.

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Na, Joo-Young; Park, Ji Hye; Choi, Byung Ha; Kim, Hyung-Seok; Park, Jong-Tae

2018-03-01

An autopsy involves examination of a body using invasive methods such as dissection, and includes various tests using samples procured during dissection. During medicolegal autopsies, the blood carboxyhemoglobin concentration is commonly measured using the AVOXimeter® 4000 as a point-of-care test. When evaluating the body following hypovolemic shock, characteristics such as reduced livor mortis or an anemic appearance of the viscera can be identified, but these observations arequite subjective. Thus, a more objective test is required for the postmortem diagnosis of anemia. In the present study, the AVOXimeter® 4000 was used to investigate the utility of point-of-care hemoglobin testing. Hemoglobin tests were performed in 93 autopsy cases. The AVOXimeter® 4000 and the BC-2800 Auto Hematology Analyzer were used to test identical samples in 29 of these cases. The results of hemoglobin tests performed with these two devices were statistically similar (r = 0.969). The results of hemoglobin tests using postmortem blood were compared with antemortem test results from medical records from 31 cases, and these results were similar. In 13 of 17 cases of death from internal hemorrhage, hemoglobin levels were lower in the cardiac blood than in blood from the affected body cavity, likely due to compensatory changes induced by antemortem hemorrhage. It is concluded that blood hemoglobin testing may be useful as a point-of-care test for diagnosing postmortem anemia.

The Effect of Carbon Monoxide Poisoning on Platelet Volume in Children

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Halise Akça

2017-04-01

Full Text Available Introduction: Carbon monoxide poisoning is one of the most important causes of morbidity and mortality. There is increasing evidence supporting the important role of mean platelet volume (MPV as a marker of hypoxia and inflammation. In this study, we aimed to determine changes in MPV values in pediatric patients with carbon monoxide poisoning. Methods: We retrospectively evaluated children who were diagnosed with carbon monoxide poisoning in our hospital between January 2005 and 2014. Results: We included 228 children with carbon monoxide poisoning (49% male in this retrospective, controlled study. The mean age of the patients was 88±56 months. Control group consisted of 200 age-matched healthy children. There was no statistically significant difference in MPV levels between the study and control groups (8.43±1.1 fL and 8.26±0.7 fL, respectively. No correlation of MPV and platelet count with carboxyhemoglobin (COHb was found. Conclusion: In our study, it was determined that MPV value was not a helpful parameter for predicting the diagnosis of acute carbon monoxide poisoning in childhood. The difference between the MPV values and the lack of significance and the absence of correlation between MPV value and COHb level led to the fact that MPV was not a guide indicating the clinical severity of the condition.

A study on structural changes in protein by time-division type Laue method

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Morimoto, Hideki [Osaka Univ., Toyonaka (Japan). Faculty of Engineering Science

1995-11-01

In order to know the physiological roles of proteins, it is important to investigate the intermediate states of their structural changes. The sizes of proteins are generally several tens angstrom(A). Considering the resolution, only x-ray crystal analysis can be used in practice for the investigation of the mechanism of protein structural changes, though NMR is applicable only for small-sized proteins. However, x-ray analysis is not so suitable for analysis of their intermediate states. Thus, the author paid attention to the time-division type Laue method for the study of hemoglobin (Hb). Laser-flash induces to release carbonmonooxide (CO) from carboxyhemoglobin (Hb(CO){sub 4}). Therefore, if an appropriate length of x-ray pulse ({approx}100 picosec) is available, the processes in the period from cleavage of the bond between a ligand (O{sub 2}, CO or NO) and Hb to recombination of them might be monitored. Using DNA recombination and chemical modification techniques, recombinant Hb, of which T structure is stable was produced. An investigation on the conditions which allow to release CO from the Hb is undertaken using a single crystal of this Hb. The experimental systems applicable to time-division type Laue method are some protein molecules participating in chemical reactions inducible by light absorption, the electron-transfer system excited by light and so on. (M.N.)

Response of Hepatoma 9618a and Normal Liver to Host Carbogen and Carbon Monoxide Breathing

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Simon P. Robinson

1999-12-01

Full Text Available The effects of hyperoxia (induced by host carbogen 95% oxygen/5% carbon dioxide breathing. and hypoxia (induced by host carbon monoxide CO at 660 ppm. breathing were compared by using noninvasive magnetic resonance (MR methods to gain simultaneous information on blood flow/oxygenation and the bioenergetic status of rat Morris H9618a hepatomas. Both carbogen and CO breathing induced a 1.5- to 2-fold increase in signal intensity in blood oxygenation level dependent (BOLD MR images. This was due to a decrease in deoxyhemoglobin (deoxyHb, which acts as an endogenous contrast agent, caused either by formation of oxyhemoglobin in the case of carbogen breathing, or carboxyhemoglobin with CO breathing. The results were confirmed by observation of similar changes in deoxyHb in arterial blood samples examined ex vivo after carbogen or CO breathing. There was no change in nucleoside triphosphates (NTP/PI in either tumor or liver after CO breathing, whereas NTP/Pl increased twofold in the hepatoma (but not in the liver after carbogen breathing. No changes in tumor intracellular pH were seen after either treatment, whereas extracellular pH became more alkaline after CO breathing and more acid after carbogen breathing, respectively. This tumor type and the liver are unaffected by CO breathing at 660 ppm, which implies an adequate oxygen supply.

Edaravone attenuates brain damage in rats after acute CO poisoning through inhibiting apoptosis and oxidative stress.

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Li, Qin; Bi, Ming Jun; Bi, Wei Kang; Kang, Hai; Yan, Le Jing; Guo, Yun-Liang

2016-03-01

Acute carbon monoxide (CO) poisoning is the most common cause of death from poisoning all over the world and may result in neuropathologic and neurophysiologic changes. Acute brain damage and delayed encephalopathy are the most serious complication, yet their pathogenesis is poorly understood. The present study aimed to evaluate the neuroprotective effects of Edaravone against apoptosis and oxidative stress after acute CO poisoning. The rat model of CO poisoning was established in a hyperbaric oxygen chamber by exposed to CO. Ultrastructure changes were observed by transmission electron microscopy (TEM). TUNEL stain was used to assess apoptosis. Immunohistochemistry and immunofluorescence double stain were used to evaluate the expression levels of heme oxygenase-1 (HO-1) and nuclear factor erythroid 2-related factor 2 (Nrf-2) protein and their relationship. By dynamically monitored the carboxyhemoglobin (HbCO) level in blood, we successfully established rat model of severe CO poisoning. Ultrastructure changes, including chromatin condensation, cytoplasm dissolution, vacuoles formation, nucleus membrane and cell organelles decomposition, could be observed after CO poisoning. Edaravone could improve the ultrastructure damage. CO poisoning could induce apoptosis. Apoptotic cells were widely distributed in cortex, striatum and hippocampus. Edaravone treatment attenuated neuronal apoptosis as compared with the poisoning group (P Edaravone, the expression of HO-1 and Nrf-2 significantly increased (P Edaravone may inhibit apoptosis, activate the Keapl-Nrf/ARE pathway, and thus improve the ultrastructure damage and neurophysiologic changes following acute CO poisoning. © 2014 Wiley Periodicals, Inc.

Carbon Monoxide Poisoning Cases Autopsied in South Marmara Region

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Filiz Eren

2014-10-01

Full Text Available Carbonmonoxide (CO related deaths, which are generally preventable accidents that include accidents due to the coal stoves and water heaters in bath at home, the mining accidents, and other accidents. CO accept as the most common cause of poisoning cases in many countries and its prominent feature is being a colorless, odorless and nonirritant gas. In the period from 2007 until the end of 2011, the autopsy records of the ........ of Turkey were reviewed. Over a period of 5 years a total of 5782 autopsies were done of which 218 involved CO poisoning, constituting 3,8 % of total cases. Information regarding age, sex, month, year, and as well as various aspects were examined. Study data were encoded with computer and Statistical analysis was performed using SPSS for windows program. Of the cases 76 were (34,9% female, 142 were (65,1% male and male/female ratio was 1,9. Of the cases average age was 46.8, range between 1 and 90 years. 57,8% of deaths were in winter markedly. The highest carboxyhemoglobin saturation was 92% in the blood. Poisoning due to CO leaks from coal heaters is an important problem in our country and surrounding regions. The mining accidents should be reduced by increasing safety in the workplace. We must more expend efforts to educate the public and prevent CO poisoning. Key words: Carbon monoxide, poisoning, autopsy.

Optical noninvasive calculation of hemoglobin components concentrations and fractional oxygen saturation using a ring-scattering pulse oximeter

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Abdallah, Omar; Stork, Wilhelm; Muller-Glaser, Klaus

2004-06-01

The deficiencies of the currently used pulse oximeter are discussed in diverse literature. A hazardous pitfalls of this method is that the pulse oximeter will not detect carboxyhemoglobin (COHb) and methemoglobin (metHb) concentrations. This leads to incorrect measurement of oxygen saturation by carbon monoxide poisoning and methemoglobinemia. Also the total hemoglobin concentration will not be considered and can only be measured in-vitro up to now. A second pitfall of the standard pulse oximetry is that it will not be able to show a result by low perfusion of tissues. This case is available inter alia when the patient is under shock or has a low blood pressure. The new non-invasive system we designed measures the actual (fractional) oxygen saturation and hemoglobin concentration. It will enable us also to measure COHb and metHb. The measurement can be applied at better perfused body central parts. Four or more light emitting diodes (LEDs) or laser diodes (LDs) and five photodiodes (PDs) are used. The reflected light signal detected by photodiodes is processed using a modified Lambert-Beer law (I=I0×e-α.d ). According to this law, when a non scattering probe is irradiated with light having the incident intensity I0, the intensity of transmitted light I decays exponentially with the absorption coefficient a of that probe and its thickness d. Modifications of this law have been performed following the theoretical developed models in literature, Monte Carlo simulation and experimental measurement.

Temperature-induced variation in the intrinsic hyperfine separation of a tightly bound nitroxide spin label

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Johnson, M.E.

1979-01-01

Recently there has been increasing interest in studying the rotational motion of biological molecules by monitoring the electron paramagnetic resonance (EPR) spectra of spin labels which are tightly bound to the molecule of interest. Theoretical studies have shown that in the slow motion region the correlation time may be determined by comparing the apparent hyperfine separation (HFS) in the presence of rotational motion with the rigid limit HFS in the absence of rotational motion. The majority of work to date has assumed the tightly bound nitroxide label to act simply as a reporter group for molecular motion, exhibiting little or no intrinsic environmental or temperature sensitivity. However, we have demonstrated that the rigid limit EPR spectra exhibit a substantial intrinsic temperature dependence, with the rigid limit HFS of MAL-6-labelled carboxyhemoglobin (HbCO) decreasing by nearly 10G over the temperature range -196/sup 0/C to +45/sup 0/C. The steepest temperature dependence was also found to occur over the 0 to 40/sup 0/C temperature range where most biological measurements are made. This strong temperature dependence in the intrinsic HFS was shown to produce substantial errors in correlation time calculations if it was not explicitly recognized and appropriate corrections made. This detailed behavior of this intrinsic temperature dependence suggests that it is most probably produced by equilibrium hydrogen bonding between the nitroxide NO/sup ./ group and an unidentified proton donor within the spin label binding site. (RJC)

Age, smoking habits, heat stress, and their interactive effects with carbon monoxide and peroxyacetyl nitrate on man's aerobic power

Energy Technology Data Exchange (ETDEWEB)

Raven, P.B.; Drinkwater, B.L.; Horvath, S.M.; Ruhling, R.O.; Gliner, J.A.; Sutton, J.C.; Bolduan, N.W.

1972-10-01

The interactive effects of age, smoking habits, and heat stress with carbon monoxide and peroxyacetyl nitrate inhalation on human aerobic power were examined. The subjects included 16 healthy middle-aged males (40-57 years); nine were nonsmokers and seven were smokers. There was no significant change in maximum aerobic power related to the presence of either air pollutant, although total working time was lowered at a temperature of 25/sup 0/C for subjects breathing 50 ppM CO. Older nonsmokers did show a decrement in maximum aerobic power while breathing 50 ppM CO, while older smokers failed to show any change. This difference, however, was related to the initial carboxyhemoglobin levels of the smokers who, when breathing this level of CO, showed only a 14 percent increase in COHb over the initial level as compared to a 200 percent increase in the nonsmokers. Smoking habits were the most influential factor affecting cardiorespiratory responses to maximal exercise in older men. Regardless of ambient conditions, smokers showed a significantly lower (27 percent) aerobic power than nonsmokers. They were also breathing closer to their maximal breathing capacities throughout the exercise period and showed a higher respiratory exchange ratio. The maximum aerobic power of nonsmokers was only 6 percent less than that of younger nonsmokers working under similar conditions, while the aerobic power of the older smokers was 26 percent lower than that of young smokers (24 years).

Effect of carbon monoxide breathing on hypoxia and radiation response in the SCCVII tumor in vivo

International Nuclear Information System (INIS)

Grau, C.; Marianne, M.D.; Nordsmark, M.; Khalil, A.A.; Horsman, M.R.; Overgaard, J.

1994-01-01

The purpose of this study was the influence of a clinically relevant concentration of carbon monoxide (CO) on tumor oxygenation and responses to irradiation. The murine tumor model was the SCCVII squamous cell carcinoma transplanted to the feet of C3H/Km mice. Sixty minutes of breathing CO at 200 ppm resulted in a carboxyhemoglobin level of 15%. This resulted in a reduction in p50 (the oxygen partial pressure at which hemoglobin is 50% saturated) to 78% of the control value, and a decrease in tumor blood perfusion to 73% of the control value. The combined effect of a decrease in effective hemoglobin and blood perfusion resulted in a reduction in tumor oxygen supply to 62% of the control value. In agreement with this, intratumoral pO 2 measurements showed a significant increase in tumor hypoxia, such that the percentage of measurements with low pO 2 (≤ 5 mmHg) increased from 33% to 62%. The fraction of clonogenic hypoxic cells, measured radiobiologically by paired cell survival curves, similarly increased from 0.2% to 3.8%. Radiation sensitivity, evaluated from in vivo-in vitro excision assay, was significantly decreased by CO in 1, 4, 8, and 12 fractions were 0.71, 0.77, 0.83, and 0.71, respectively. The present SCCVII tumor data confirm the general experimental observation that CO breathing significantly increases tumor hypoxia and reduces the effectiveness of ionizing irradiation. 22 refs., 3 figs., 2 tabs

Conformational changes in hemoglobin triggered by changing the iron charge

International Nuclear Information System (INIS)

Croci, S.; Achterhold, K.; Ortalli, I.; Parak, F. G.

2008-01-01

In this work the hemoglobin conformational changes induced by changing the iron charge have been studied and compared with Myoglobin. Moessbauer spectroscopy was used to follow the change of the iron conformation. In order to compare the conformational relaxation of hemoglobin and myoglobin, and to study a possible influence of the quaternary structure, an intermediate metastable state of hemoglobin has been created by low temperature X-ray irradiation of methemoglobin. The irradiation reduces the Fe(III) of the heme groups to Fe(II) Low Spin, where the water is still bound on the sixth coordination. Heating cycles performed at temperatures from 140 K to 200 K allow the molecules to overcome an activation energy barrier and to relax into a stable conformation such as deoxy-hemoglobin or carboxy-hemoglobin, if CO is present. Slightly different structures (conformational substates) reveal themselves as a distribution of energy barriers (ΔG). The distribution of the activation energy, for the decay of the Fe(II) Low Spin intermediate, has been fitted with a Gaussian. For comparison, published myoglobin data were re-analysed in the same way. The average energy value at characteristic temperature is very similar in case of myoglobin and hemoglobin. The larger Gaussian energy distribution for myoglobin with respect to hemoglobin shows that more conformational substates are available. This may be caused by a larger area exposed to water. In hemoglobin, part of the surface of the chains is not water accessible due to the quaternary structure.

Hypothermia-Related Acute Pancreatitis

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Kyawzaw Lin

2018-05-01

Full Text Available Acute pancreatitis (AP is an inflammatory disease presenting from mild localized inflammation to severe infected necrotic pancreatic tissue. In the literature, there are a few cases of hypothermia-induced AP. However, the association between hypothermia and AP is still a myth. Generally, mortality from acute pancreatitis is nearly 3–6%. Here, we present a 40-year-old chronic alcoholic female who presented with acute pancreatitis induced by transient hypothermia. A 40-year-old chronic alcoholic female was hypothermic at 81°F on arrival which was improved to 91.7°F with warming blanket and then around 97°F in 8 h. Laboratory tests including complete blood count, lipid panel, and comprehensive metabolic panels were within the normal limit. Serum alcohol level was 0.01, amylase 498, lipase 1,200, ammonia 26, serum carboxyhemoglobin level 2.4, and β-HCG was negative. The entire sepsis workup was negative. During rewarming period, she had one episode of witnessed generalized tonic-clonic seizure. It was followed by transient hypotension. Fluid challenge was successful with 2 L of normal saline. Sonogram (abdomen showed fatty liver and trace ascites. CAT scan (abdomen and pelvis showed evidence of acute pancreatitis without necrosis, peripancreatic abscess, pancreatic mass, or radiopaque gallstones. The patient was managed medically and later discharged from the hospital on the 4th day as she tolerated a normal low-fat diet. In our patient, transient hypothermia from chronic alcohol abuse and her social circumstances might predispose to microcirculatory disturbance resulting in acute pancreatitis. Early and aggressive fluid resuscitation prevents complications.

Combined treatment of methylprednisolone pulse and memantine hydrochloride prompts recovery from neurological dysfunction and cerebral hypoperfusion in carbon monoxide poisoning: a case report.

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Iwamoto, Konosuke; Ikeda, Ken; Mizumura, Sunao; Tachiki, Kazuhiro; Yanagihashi, Masaru; Iwasaki, Yasuo

2014-03-01

A 49-year-old healthy man developed sudden unconsciousness under inadequate ventilation. Blood gas analysis showed carboxyhemoglobin of 7.3%. After normobaric oxygen therapy, he recovered completely 7 days later. At 3 weeks after carbon monoxide (CO) exposures, memory and gait disturbances appeared. Neurological examination revealed Mini-Mental State Examination (MMSE) score of 5 of 30 points, leg hyper-reflexia with Babinski signs, and Parkinsonism. Brain fluid-attenuated inversion recovery imaging disclosed symmetric hypointense lesions in the thalamus and the globus pallidus, and hyperintense lesions in the cerebral white matter. Brain single-photon emission tomography (SPECT) scanning with (99m)Technesium-ethyl cysteinate dimer displayed marked hypoperfusion in the cerebellum, the thalamus, the basal ganglia, and the entire cerebral cortex. He was diagnosed as CO poisoning and treated with hyperbaric oxygen therapy. The neurological deficits were not ameliorated. At 9 weeks after neurological onset, methylprednisolone (1000 mg/day, intravenous, 3 days) and memantine hydrochloride (20 mg/day, per os) were administered. Three days later, MMSE score was increased from 3 to 20 points. Neurological examination was normal 3 weeks later. Brain SPECT exhibited 20% increase of regional cerebral blood flows in the cerebellum, the thalamus, the basal ganglia, and the entire cerebral cortex. These clinicoradiological changes supported that the treatment with steroid pulse and memantine hydrochloride could prompt recovery from neurological dysfunction and cerebral hypoperfusion. Further clinical trials are warranted whether such combined therapy can attenuate neurological deficits and cerebral hypoperfusion in patients with CO poisoning. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Unusual way of suicide by carbon monoxide. Case Report.

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Zelený, Michal; Pivnička, Jan; Šindler, Martin; Kukleta, Pavel

2015-01-01

Authors discuss the case of a suicide of a 29-year-old man caused by carbon monoxide (CO) intoxication. What the authors found interesting was the unusual way of committing suicide that required good technical skills and expert knowledge. The level of carboxyhemoglobin (COHb) in the blood of the deceased man was routinely determined by the modified method by Blackmoore (1970), using gas chromatography/thermal conductivity detection. The level of saturation of the hemoglobin by CO in the collected blood sample is determined relatively to the same sample saturated to 100%. In the blood sample of the deceased man the lethal concentration of COHb of 76.5% was determined. Within the following examinations the blood alcohol concentration of 0.05 g.kg(-1) was determined. Further analysis revealed traces of sertraline, its metabolite N-desmethylsertraline, omeprazole and caffeine in the liver tissue, traces of N-desmethylsertraline, ibuprofen and caffeine in urine sample, and only traces of caffeine in the stomach content and blood samples were proved. To commit suicide the man used a sophisticated double container-system equipped with a timer for controlled generation of CO based on the chemical reaction of concentrated sulphuric acid and formic acid. The used timer was set by an electromechanical timer switch that triggered the fatal reaction of the acids while the man was sleeping. The authors discuss an unusual case of suicide by CO intoxication rarely seen in the area of forensic medicine and toxicology that is specific due to its sophisticated way of execution.

Exposure to Elevated Carbon Monoxide Levels at an Indoor Ice Arena--Wisconsin, 2014.

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Creswell, Paul D; Meiman, Jon G; Nehls-Lowe, Henry; Vogt, Christy; Wozniak, Ryan J; Werner, Mark A; Anderson, Henry

2015-11-20

On December 13, 2014, the emergency management system in Lake Delton, Wisconsin, was notified when a male hockey player aged 20 years lost consciousness after participation in an indoor hockey tournament that included approximately 50 hockey players and 100 other attendees. Elevated levels of carbon monoxide (CO) (range = 45 ppm-165 ppm) were detected by the fire department inside the arena. The emergency management system encouraged all players and attendees to seek medical evaluation for possible CO poisoning. The Wisconsin Department of Health Services (WDHS) conducted an epidemiologic investigation to determine what caused the exposure and to recommend preventive strategies. Investigators abstracted medical records from area emergency departments (EDs) for patients who sought care for CO exposure during December 13-14, 2014, conducted a follow-up survey of ED patients approximately 2 months after the event, and conducted informant interviews. Ninety-two persons sought ED evaluation for possible CO exposure, all of whom were tested for CO poisoning. Seventy-four (80%) patients had blood carboxyhemoglobin (COHb) levels consistent with CO poisoning; 32 (43%) CO poisoning cases were among hockey players. On December 15, the CO emissions from the propane-fueled ice resurfacer were demonstrated to be 4.8% of total emissions when actively resurfacing and 2.3% when idling, both above the optimal range of 0.5%-1.0%. Incomplete fuel combustion by the ice resurfacer was the most likely source of elevated CO. CO poisonings in ice arenas can be prevented through regular maintenance of ice resurfacers, installation of CO detectors, and provision of adequate ventilation.

Quantitative evaluation of volatile hydrocarbons in post-mortem blood in forensic autopsy cases of fire-related deaths.

Science.gov (United States)

Yonemitsu, Kosei; Sasao, Ako; Oshima, Toru; Mimasaka, Sohtaro; Ohtsu, Yuki; Nishitani, Yoko

2012-04-10

Volatile hydrocarbons in post-mortem blood from victims of fires were analyzed quantitatively by headspace gas chromatography mass spectrometry. The benzene and styrene concentrations in the blood were positively correlated with the carboxyhemoglobin (CO-Hb) concentration, which is evidence that the deceased inhaled the hydrocarbons and carbon monoxide simultaneously. By contrast, the concentrations of toluene and CO-Hb in the blood were not significantly correlated. This lack of correlation could be explained by two different sources of toluene, with low blood concentrations of toluene arising when the deceased inhaled smoke and high blood concentrations of toluene arising when the deceased inhaled petroleum vapor or other unknown vapors. The quantity of soot deposited in the respiratory tract was classified into four grades (-, 1+, 2+, 3+). The mean CO-Hb concentration in the 1+ soot group was significantly lower than those in the 2+ (ptypes of smoke produced by different materials. For example, petroleum combustion with a limited supply of oxygen, like in a compartment fire, may produce a large volume of dense black smoke that contains a large quantity of soot. Soot deposits in the airways and the blood CO-Hb concentration are basic and essential autopsy findings that are used to investigate fire-related deaths. The quantitative GC-MS analysis of blood volatile hydrocarbons can provide additional useful information on the cause of the fire and the circumstances surrounding the death. In combination, these three findings are useful for the reconstruction of cases. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Impaired mitochondrial respiration and protein nitration in the rat hippocampus after acute inhalation of combustion smoke

International Nuclear Information System (INIS)

Lee, Heung M.; Reed, Jason; Greeley, George H.; Englander, Ella W.

2009-01-01

Survivors of massive inhalation of combustion smoke endure critical injuries, including lasting neurological complications. We have previously reported that acute inhalation of combustion smoke disrupts the nitric oxide homeostasis in the rat brain. In this study, we extend our findings and report that a 30-minute exposure of awake rats to ambient wood combustion smoke induces protein nitration in the rat hippocampus and that mitochondrial proteins are a sensitive nitration target in this setting. Mitochondria are central to energy metabolism and cellular signaling and are critical to proper cell function. Here, analyses of the mitochondrial proteome showed elevated protein nitration in the course of a 24-hour recovery following exposure to smoke. Mass spectrometry identification of several significantly nitrated mitochondrial proteins revealed diverse functions and involvement in central aspects of mitochondrial physiology. The nitrated proteins include the ubiquitous mitochondrial creatine kinase, F1-ATP synthase α subunit, dihydrolipoamide dehydrogenase (E3), succinate dehydrogenase Fp subunit, and voltage-dependent anion channel (VDAC1) protein. Furthermore, acute exposure to combustion smoke significantly compromised the respiratory capacity of hippocampal mitochondria. Importantly, elevated protein nitration and reduced mitochondrial respiration in the hippocampus persisted beyond the time required for restoration of normal oxygen and carboxyhemoglobin blood levels after the cessation of exposure to smoke. Thus, the time frame for intensification of the various smoke-induced effects differs between blood and brain tissues. Taken together, our findings suggest that nitration of essential mitochondrial proteins may contribute to the reduction in mitochondrial respiratory capacity and underlie, in part, the brain pathophysiology after acute inhalation of combustion smoke

Correlation between clinical severity and different non-invasive measurements of carbon monoxide concentration: A population study.

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Thomas Hullin

Full Text Available Carbon monoxide (CO poisoning is a major concern in industrialized countries. Each year, thousands of victims, resulting in approximately 100 fatalities, are encountered in France. The diagnosis of CO poisoning is challenging; while carboxyhemoglobin (COHb may be useful, it is a weak indicator of the severity of CO poisoning. This weak indicator may be a result of the delay between poisoning occurrence and the blood assay. Two apparatuses, CO oximeters and exhaled CO analyzers, now permit COHb to be determined outside hospitals. Our hypothesis is that these instruments allow the early measurement of COHb concentrations, which are more correlated with the severity of poisoning, expressed using the poisoning severity score (PSS.In an observational and retrospective cohort study, the distribution of COHb measurements obtained by CO oximetry or by exhaled CO analyzers was compared between groups of severity expressed using the PSS.Data were collected in the Paris area from January 2006 to December 2010 by the French Surveillance System of CO poisoning.All patients with CO poisoning reported to the French Surveillance System of CO poisoning.There was a significant difference in the COHb values obtained by CO oximetry between groups stratified according to PSS (p<0.0001. A significant difference in the values of exhaled CO was also observed between PSS groups (p = 0.006, although the relationship was not linear.The COHb concentrations measured using CO oximetry, but not those measured using exhaled CO analyzers, were well correlated with the severity of CO poisoning.

Cerebral Venous Thrombosis and Venous Infarction: Case Report of a Rare Initial Presentation of Smoker’s Polycythemia

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Mihir Raval

2010-11-01

Full Text Available Introduction: Cerebral venous thrombosis is a rare initial presentation of polycythemia. If diagnosed early, treatment can reduce mortality and morbidity significantly. Often it may present with headache as the only complaint, and thus the diagnosis is likely to be missed. Case Presentation: A medically stable 31-year-old male, a chronic smoker with a ∼17 pack-year history of smoking, was admitted to the emergency room with a 2-week history of gradually worsening, severe, throbbing headache in the occipital region sensitive to light. Initial neurological examination was positive only for some involuntary motor tics of the left leg. Initial laboratory workup showed hemoglobin of 20 g/dl and hematocrit of 56.5%. The carboxyhemoglobin level was normal, but the oxygen dissociation curve was shifted to the left. Further evaluation by MRI and MRA of the brain suggested extensive and complete thrombosis of the superior sagittal sinus, right transverse sinus and right sigmoid sinus with a small venous infarct in the right parafrontal region. Given that the patient first presented with a thrombotic event, workup for primary polycythemia and hypercoagulable disorders was carried out, including JAK2 mutation evaluation, which was negative. This left us with smoking as the only risk factor and possible cause for secondary polycythemia. He improved significantly with phlebotomy and anticoagulation treatment. Conclusion: This case illustrates a rare but severe complication of secondary polycythemia stressing the importance of being aware of the risk of developing cerebral thrombosis in patients with chronic smoking exposure.

Assessing inhalation injury in the emergency room

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Tanizaki S

2015-07-01

Full Text Available Shinsuke Tanizaki Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan Abstract: Respiratory tract injuries caused by inhalation of smoke or chemical products are related to significant morbidity and mortality. While many strategies have been built up to manage cutaneous burn injuries, few logical diagnostic strategies for patients with inhalation injuries exist and almost all treatment is supportive. The goals of initial management are to ensure that the airway allows adequate oxygenation and ventilation and to avoid ventilator-induced lung injury and substances that may complicate subsequent care. Intubation should be considered if any of the following signs exist: respiratory distress, stridor, hypoventilation, use of accessory respiratory muscles, blistering or edema of the oropharynx, or deep burns to the face or neck. Any patients suspected to have inhalation injuries should receive a high concentration of supplemental oxygen to quickly reverse hypoxia and to displace carbon monoxide from protein binding sites. Management of carbon monoxide and cyanide exposure in smoke inhalation patients remains controversial. Absolute indications for hyperbaric oxygen therapy do not exist because there is a low correlation between carboxyhemoglobin levels and the severity of the clinical state. A cyanide antidote should be administered when cyanide poisoning is clinically suspected. Although an ideal approach for respiratory support of patients with inhalation injuries do not exist, it is important that they are supported using techniques that do not further exacerbate respiratory failure. A well-organized strategy for patients with inhalation injury is critical to reduce morbidity and mortality. Keywords: inhalation injury, burn, carbon monoxide poisoning, cyanide poisoning

An Outbreak of Carbon Monoxide Poisoning in Yamagata Prefecture Following the Great East Japan Earthquake

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Ken Iseki

2013-06-01

Full Text Available Background: In the aftermath of the Great East Japan Earthquake, most of the areas in Yamagata prefecture experienced a serious power failure lasting for approximately 24 hours. A number of households were subsequently poisoned with carbon monoxide (CO due to various causes. In this study, we conducted a survey of CO poisoning during the disaster. Methods: A questionnaire regarding CO poisoning associated with the disaster was sent to 37 emergency hospitals in Yamagata prefecture. Results: A total of 51 patients were treated for unintentional CO poisoning in 7 hospitals (hyperbaric oxygen chambers were present in 3 of the hospitals. The patients (18 men, 33 women ranged in age from 0 to 90 years. The source of CO exposure was charcoal briquettes (23 cases; 45%, gasoline-powered electric generators (18 cases; 35%, electric generators together with oil stoves (8 cases; 16%, oil stoves (1 cases; 2%, and automobile exhaust (1 cases; 2%. Blood carboxyhemoglobin levels ranged from 0.5% to 41.6% in 49 cases. Of these, 41 patients were treated by normobaric oxygen therapy, while one was intubated for artificial respiration. Additionally, 5 patients (10% were treated by hyperbaric oxygen therapy, and 3 patients (6% experienced delayed neuropsychiatric sequelae. Conclusion: CO sources included gasoline-powered electric generators and charcoal briquettes during the disaster. Storm-related CO poisoning is well recognized as a disaster-associated accident in the United States, but not in Japan. We emphasize that public education is needed to make people aware of the dangers of CO poisoning after a disaster. In addition, a pulse CO-oximeter should be set up in hospitals.  

An air quality assessment onboard an Oberon class submarine : HMCS Okanagan

International Nuclear Information System (INIS)

Severs, Y.D.; Sabiston, B.H.

2000-09-01

The Defence and Civil Institute of Environmental Medicine (DCIEM) re-examined the air quality on an Oberon class submarine, the HMCS Okanagan, to determine if the atmosphere complied with Air Purification Standard BR 1326. The main objective of the assessment was to help in the development of future submarine air quality management. The information obtained from the Oberon class submarine could be readily applied to the Victoria class submarines. The assessment involved a trial aboard an Oberon under patrol conditions. The functional and detection capabilities of analytical air monitoring instruments were assessed for a 24-hour period to obtain data regarding the contaminants onboard the submarine. A profile of carbon dioxide accumulation and oxygen consumption was determined. This was followed by an assessment of the effectiveness of air purification such as carbon dioxide scrubbing, oxygen generation and snorting. Carbon monoxide was also monitored and carboxyhemoglobin was measured in both smokers and non-smokers. In order to determine if the sanitary or electrical systems, or engine exhaust posed any danger, ammonia, ozone and nitrous compounds were also measured. In addition, hydrogen, arsine and stibene were monitored to determine any possible danger from charging batteries. The health risks associated with aerosolized particles from cooking, smoking and exhaust gases were also measured. Results showed that all contaminants were within allowable limits. However, the study also confirmed that air purification measures on diesel submarines are minimal and poorly placed and that there is a lack of exhaust ventilation. Poor air exchange was worsened by compartmentalization and blackout curtains. Several recommendations were proposed to improve the management of air quality in Victoria class submarines. 18 refs., 2 tabs., 5 figs

Tar, CO and delta 9THC delivery from the 1st and 2nd halves of a marijuana cigarette.

Science.gov (United States)

Tashkin, D P; Gliederer, F; Rose, J; Chang, P; Hui, K K; Yu, J L; Wu, T C

1991-11-01

Previous in vitro studies suggest that, with successive puffs from a marijuana cigarette, delta-9-THC becomes concentrated in the remaining uncombusted portion of the cigarette. These observations are consistent with the common practice of smoking marijuana cigarettes to a smaller butt length than that to which tobacco cigarettes are smoked. The purpose of the present study was to compare the delivery of delta-9-THC, as well as total insoluble smoke particulates (tar) and carbon monoxide, from the distal ("first") versus the proximal ("second") halves of a standard marijuana cigarette during "natural" smoking of marijuana. On 4 separate days, ten habitual marijuana users smoked nearly all or approximately 1/2 of a standard marijuana cigarette (83 mm length; 800-900 mg; 1.24% THC), as follows: day 1, "whole" cigarette (60 mm smoked, leaving a 23-mm butt); day 2, "first" half (first 30 mm); day 3, "second" half (second 30 mm) after the "first" half was presmoked with a syringe; and day 4, "second" half after the "first" half was excised. A previously described smoking apparatus (20) was used for measurement of puff volume and inhaled tar. Puff volume and number were allowed to vary spontaneously (provided that the specified length of cigarette was consumed), while inhaled volume (1.5 liters), breathholding time (14 s) and interpuff interval (30 s) were held constant. Blood samples were withdrawn prior to smoking and serially after completion of smoking for analysis of blood carboxyhemoglobin (COHb) and serum delta-9-THC. Heart rate was measured before and 5 min after smoking. Subjects rated their level of "high" 20 min after completion of smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Occupational carbon monoxide poisoning in the State of Washington, 1994-1999.

Science.gov (United States)

Lofgren, Don J

2002-04-01

Carbon monoxide poisonings continue to be significant and preventable for a number of work operations. This study assesses occupational carbon monoxide morbidity and mortality for the state of Washington based on a review of workers' compensation records for the years 1994-1999. The study characterizes sources, industries, and causative factors, and further attempts to identify work operations most at risk. Records were identified by both injury source and diagnostic codes. The study limits itself to non-fire-related carbon monoxide poisonings and primarily those from acute exposure. A decline in the number of claims was not evident, but the number of incidents per year showed a slight decline. Carbon monoxide poisonings were found to occur throughout all types of industries. The greatest number of claims was found in agriculture, followed by construction and wholesale trade, with these three accounting for more than half the claims and nearly half of the incidents. The more severe poisonings did not necessarily occur in industries with the greatest number of incidents. The major source for carbon monoxide poisoning was forklift trucks, followed by auto/truck/bus, portable saws, and more than 20 other sources. Fruit packing and storage had the highest number of incidents mostly due to fuel-powered forklift activity, with nearly half of the incidents occurring in cold rooms. Adverse health effects as measured by carboxyhemoglobin, hyperbaric oxygen treatment, unconsciousness, and number and cost of claims were indexed by source. Though several specific work operations were identified, the episodic nature of carbon monoxide poisonings, as well as the diverse industries and sources, and the opportunity for a severe poisoning in any number of operations, poses challenges for effective intervention.

Carbon monoxide poisoning in children riding in the back of pickup trucks.

Science.gov (United States)

Hampson, N B; Norkool, D M

OBJECTIVE - To describe the case characteristics of a series of children poisoned with carbon monoxide while traveling in the back of pickup trucks. DESIGN - Pediatric cases referred for treatment of carbon monoxide poisoning with hyperbaric oxygen between 1986 and 1991 were reviewed. Those cases that occurred during travel in the back of pickup trucks were selected. Clinical follow-up by telephone interview ranged from 2 to 55 months. SETTING - A private, urban, tertiary care center in Seattle, Wash. PATIENTS - Twenty children ranging from 4 to 16 years of age. INTERVENTION - All patients were treated with hyperbaric oxygen. MAIN OUTCOME MEASURES - Characteristics of the poisoning incident and clinical patient outcome. RESULTS - Of 68 pediatric patients treated for accidental carbon monoxide poisoning, 20 cases occurred as children rode in the back of pickup trucks. In 17 of these, the children were riding under a rigid closed canopy on the rear of the truck, while three episodes occurred as children rode beneath a tarpaulin. Average carboxyhemoglobin level on emergency department presentation was 18.2% +/- 2.4% (mean +/- SEM; range, 1.6% to 37.0%). Loss of consciousness occurred in 15 of the 20 children. One child died of cerebral edema, one had permanent neurologic deficits, and 18 had no recognizable sequelae related to the episode. In all cases, the truck exhaust system had a previously known leak or a tail pipe that exited at the rear rather than at the side of the pickup truck. CONCLUSIONS - Carbon monoxide poisoning is a significant hazard for children who ride in the back of pickup trucks. If possible, this practice should be avoided.

Effect of exhaust emissions on carbon monoxide levels in employees working at indoor car wash facilities.

Science.gov (United States)

Topacoglu, H; Katsakoglou, S; Ipekci, A

2014-01-01

Exhaust emissions from motor vehicles threaten the environment and human health. Carbon monoxide (CO) poisoning, especially the use of exhaust gas CO in suicidal attempts is well known in the literature. Recently, indoor car wash facilities established in large shopping malls with closed parking, lots is a new risk area that exposes car wash employees to prolonged periods of high level CO emissions from cars. The aim of this study was to investigate how carboxyhemoglobin (COHb) blood levels of employees get affected in confined areas with relatively poor air circulation. Twenty male volunteers working in indoor parking car wash facilities were included in the study. Participants were informed about the aim of this study and their consent was obtained. Their pulse COHb levels were measured twice, at the beginning and at the end of the working day using Rad-57 pulse CO-oximeter device, allowing non-invasive measurement of COHb blood levels to compare the changes in their COHb levels before and after work. The mean age of the male volunteers was 29.8 ± 11.9 (range 18-55). While the mean COHb levels measured at the start of the working day was 2.1 ± 2.0 (range 0-9), it was increased to 5.2 ± 3.3 (range 1-15) at the end of work shift (Wilcoxon test, p car wash facility employees is directly impacted and gets elevated by motor vechile exhaust emissions. For the health of the employees at indoor parking car wash facilities, stricter precautions are needed and the government should not give permit to such operations.

Electrocardiographic Findings and Serum Troponin I in Carbon Monoxide Poisoned Patients

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Scott Reza Jafarian Kerman

2012-03-01

Full Text Available Carbon monoxide (CO poisoning, though with different sources, is one of the most deadly emergencies in all countries. CO can threaten men's life by several paths especially cardiac complications, which can mimic other cardiac problems such as myocardial infarction. The objective of this study was to determine ECG findings and serum troponin I levels in CO poisoned patients. In this analytical cross-sectional study, 63 CO poisoning patients were consecutively included from hospital's emergency departments. CO content was measured by a CO-oximeter and an electrocardiography was taken first thing on admission. Arterial blood gas (ABG, troponin I and other data was collected afterwards. Data were divided by age groups (adults and children and gender. CO content was significantly higher only in subjects with normal T wave compared to patients with inverted T wave in their initial ECG (P=0.016. No other significant difference was noticed. None of the ABG findings correlated significantly with CO content. Also no significant correlation was found with CO content after stratification by gender and age groups, but pH in children (r=-0.484, P=0.026. CO content was significantly higher in adults (P=0.023, but other ABG data were not significantly different. Only 3 patients had elevated troponin I. Receiver operating characteristic (ROC analysis showed no significant cutoff points in CO content for ECG changes. No significant specific change in electrocardiograms (ECG could contribute carboxyhemoglobin content in carbon monoxide poisoned patients. In addition, no specific difference was found between adults and pediatric subjects' ECGs. All other findings seemed to be accidental.

An air quality assessment onboard an Oberon class submarine : HMCS Okanagan

Energy Technology Data Exchange (ETDEWEB)

Severs, Y.D.; Sabiston, B.H.

2000-09-01

The Defence and Civil Institute of Environmental Medicine (DCIEM) re-examined the air quality on an Oberon class submarine, the HMCS Okanagan, to determine if the atmosphere complied with Air Purification Standard BR 1326. The main objective of the assessment was to help in the development of future submarine air quality management. The information obtained from the Oberon class submarine could be readily applied to the Victoria class submarines. The assessment involved a trial aboard an Oberon under patrol conditions. The functional and detection capabilities of analytical air monitoring instruments were assessed for a 24-hour period to obtain data regarding the contaminants onboard the submarine. A profile of carbon dioxide accumulation and oxygen consumption was determined. This was followed by an assessment of the effectiveness of air purification such as carbon dioxide scrubbing, oxygen generation and snorting. Carbon monoxide was also monitored and carboxyhemoglobin was measured in both smokers and non-smokers. In order to determine if the sanitary or electrical systems, or engine exhaust posed any danger, ammonia, ozone and nitrous compounds were also measured. In addition, hydrogen, arsine and stibene were monitored to determine any possible danger from charging batteries. The health risks associated with aerosolized particles from cooking, smoking and exhaust gases were also measured. Results showed that all contaminants were within allowable limits. However, the study also confirmed that air purification measures on diesel submarines are minimal and poorly placed and that there is a lack of exhaust ventilation. Poor air exchange was worsened by compartmentalization and blackout curtains. Several recommendations were proposed to improve the management of air quality in Victoria class submarines. 18 refs., 2 tabs., 5 figs.

Relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man

Energy Technology Data Exchange (ETDEWEB)

Sokal, J.A.; Kralkowska, E.

1985-08-01

The relationship between exposure duration, COHb, blood glucose, pyruvate and lactate and the severity of intoxication was investigated in a group of 39 cases of acute CO poisoning treated in the Clinical Toxicology Center in Lodz, Poland. On the basis of clinical criteria the patients were classified into cases of mild, moderate, severe and very severe CO poisoning. COHb and carbohydrate metabolites were estimated in venous blood taken immediately after admission of the patient to hospital prior to treatment. The severity of intoxication did not correlate with blood COHb; variation in exposure duration seems to be responsible for this phenomenon. Severe and very severe poisonings were associated with longer exposures and were accompanied by a markedly higher blood lactate level, compared to mild and moderate cases. Blood pyruvate depended less than lactate on the severity of intoxication. Blood glucose depended neither on exposure duration nor on the severity of intoxication. Among the carbohydrate metabolic parameters studied, blood lactate determination can be helpful in the evaluation of the severity of CO poisoning in man.

Cigarettes with different nicotine levels affect sensory perception and levels of biomarkers of exposure in adult smokers.

Science.gov (United States)

McKinney, Diana L; Frost-Pineda, Kimberly; Oldham, Michael J; Fisher, Michael T; Wang, Jingzhu; Gogova, Maria; Kobal, Gerd

2014-07-01

Few clinical studies involving cigarettes have provided a comprehensive picture of smoke exposure, test article characterization, and insights into sensory properties combined. The purpose of these pilot studies was to determine whether cigarettes with different levels of nicotine but similar tar levels would affect sensory experience or smoking behavior so as to significantly alter levels of selected biomarkers of exposure (BOE). In 2 confined, double-blind studies, 120 adult smokers switched from Marlboro Gold cigarettes at baseline to either 1 of 2 lower nicotine cigarettes or 1 of 2 higher nicotine cigarettes and then to the other cigarette after 5 days. Urinary excretion of exposure biomarkers (nicotine equivalents [NE], total and free 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL], 1-hydroxypyrene, and 3-hydroxypropyl mercapturic acid) as well as carboxyhemoglobin and plasma cotinine were measured at baseline, Day 5, and Day 10. Daily cigarette consumption was monitored and sensory characteristics were rated for each cigarette. With higher nicotine yield, urine NE, urine total NNAL, and plasma cotinine increased while nonnicotine BOE decreased without changes in cigarette consumption. In contrast, with lower nicotine yield, urine NE, urine total NNAL, and plasma cotinine dropped while nonnicotine BOE and cigarettes per day increased. Higher nicotine cigarettes were rated harsher and stronger than at baseline while lower nicotine cigarettes were less strong. All 4 test cigarettes were highly disliked. These studies demonstrate that abrupt increases or decreases in nicotine and the resulting sensory changes impact BOE through changes in intensity or frequency of smoking. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Protective Role of Carbon Monoxide (CO Produced by Heme Oxygenases and Derived from the CO-Releasing Molecule CORM-2 in the Pathogenesis of Stress-Induced Gastric Lesions: Evidence for Non-Involvement of Nitric Oxide (NO

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Katarzyna Magierowska

2016-03-01

Full Text Available Carbon monoxide (CO produced by heme oxygenase (HO-1 and HO-2 or released from the CO-donor, tricarbonyldichlororuthenium (II dimer (CORM-2 causes vasodilation, with unknown efficacy against stress-induced gastric lesions. We studied whether pretreatment with CORM-2 (0.1–10 mg/kg oral gavage (i.g., RuCl3 (1 mg/kg i.g., zinc protoporphyrin IX (ZnPP (10 mg/kg intraperitoneally (i.p., hemin (1–10 mg/kg i.g. and CORM-2 (1 mg/kg i.g. combined with NG-nitro-l-arginine (l-NNA, 20 mg/kg i.p., 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 10 mg/kg i.p., indomethacin (5 mg/kg i.p., SC-560 (5 mg/kg i.g., and celecoxib (10 mg/kg i.g. affects gastric lesions following 3.5 h of water immersion and restraint stress (WRS. Gastric blood flow (GBF, the number of gastric lesions and gastric CO and nitric oxide (NO contents, blood carboxyhemoglobin (COHb level and the gastric expression of HO-1, HO-2, hypoxia inducible factor 1α (HIF-1α, tumor necrosis factor α (TNF-α, cyclooxygenase (COX-2 and inducible NO synthase (iNOS were determined. CORM-2 (1 mg/kg i.g. and hemin (10 mg/kg i.g. significantly decreased WRS lesions while increasing GBF, however, RuCl3 was ineffective. The impact of CORM-2 was reversed by ZnPP, ODQ, indomethacin, SC-560 and celecoxib, but not by l-NNA. CORM-2 decreased NO and increased HO-1 expression and CO and COHb content, downregulated HIF-1α, as well as WRS-elevated COX-2 and iNOS mRNAs. Gastroprotection by CORM-2 and HO depends upon CO’s hyperemic and anti-inflammatory properties, but is independent of NO.

Ischemia-modified albumin levels in the prediction of acute critical neurological findings in carbon monoxide poisoning

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Murat Daş

2016-04-01

Full Text Available The aim of the study was to determine whether serum ischemia-modified albumin (IMA levels in patients with carbon monoxide (CO poisoning were higher compared with a control group of healthy volunteers. In addition, the study sought to determine if there was a correlation between serum IMA levels and carboxyhemoglobin (COHB levels and other critical neurological findings (CNFs. In this prospective study, the IMA levels of 100 patients with CO poisoning and 50 control individuals were compared. In addition, the IMA and COHB levels were analyzed according to absence or presence CNFs in patients with CO poisoning. The levels of IMA (mg/dL on admittance, and during the 1st hour and 3rd hour, in patients with CO poisoning (49.90 ± 35.43, 30.21 ± 14.81, and 21.87 ± 6.03 were significantly higher, compared with the control individuals (17.30 ± 2.88. The levels of IMA in the 6th hour were not higher compared with control individuals. The levels of IMA on admittance, and during the 1st hour, 3rd hour, and 6th hour, and COHB (% levels in patients who had CNFs were higher compared with IMA levels and COHB levels in patients who had no CNFs (p < 0.001. However, when the multivariate model was created, it was observed that IMA level on admittance was a poor indicator for prediction of CNFs (odds ratio = 1.05; 95% confidence interval, 1.01–1.08. We therefore concluded that serum IMA levels could be helpful in the diagnosis of CO poisoning. However, we believe that IMA levels cannot be used to predict which patients will develop CNFs due to CO poisoning.

Alterations in prostacyclin and thromboxane formation by chronic cigarette smoke exposure: temporal relationships and whole smoke vs. gas phase

Energy Technology Data Exchange (ETDEWEB)

Lubawy, W.C.; Culpepper, B.T.; Valentovic, M.A.

1986-04-01

Chronic cigarette smoke exposure in vivo causes decreased conversion of (/sup 14/C)arachidonic acid (AA) to prostacyclin (PGI2) by isolated aortic tissue and increased conversion to thromboxane (TXA2) by isolated platelets from rats. Alterations in the PGI2/TXA2 balance may be part of the mechanism through which smoking increases the risk of cardiovascular disease. To study the influence of smoke exposure duration on this response, male rats were exposed daily to 10 puffs of freshly generated cigarette smoke. Animals were killed after 1, 4, 14, 28 and 57 days of smoke exposure and 3, 7, 14 and 28 days after cessation of the 57-day of smoke-exposure regimen. Elevated carboxyhemoglobin levels during the smoke-exposure sessions verified smoke (gas phase) inhalation. Statistically significant alterations in prostacyclin synthesis preceded those of thromboxane. A decrease of 20-25% (P less than 0.05) in PGI2 production from (/sup 14/C)AA in isolated aortic tissue was found beginning 28 days after smoke was initiated and quickly rebounded when smoke exposure was terminated. Increased production of TXA2 from (/sup 14/C)AA by isolated platelets became statistically significant (P less than 0.05) on the 57th day and returned to normal 7-14 days after cessation of smoke exposure. To determine the effect of gas phase constituents on the PGI2/TXA2 balance a second series of experiments divided male and female Sprague-Dawley rats into sham, whole smoke and gas phase groups. Gas phase was produced by passing whole smoke through a Cambridge filter to remove particulate matter. Per cent COHb averaged 1.4 for sham, 7.8 for whole smoke and 9.4 for gas phase groups.

Potential use of hyperoxygenated solution as a treatment strategy for carbon monoxide poisoning.

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Xingxing Sun

Full Text Available AIM: Carbon monoxide (CO poisoning can cause permanent damage in tissues that are sensitive to hypoxia. We explored the feasibility and efficacy of using a hyperoxygenated solution (HOS to treat severe acute CO poisoning in an animal model. METHODS: Male Sprague-Dawley rats were subjected to CO poisoning. The HOS was administered into the femoral vein of these rats through a catheter (10 ml/kg. Carboxyhemoglobin (COHb and blood gases were used to assess the early damage caused by CO poisoning. S100β was measured to predict the development of late cognitive sequelae of CO. The Morris water maze test was performed to assess cognitive function, and Nissl staining was performed to observe histologic change. RESULTS: The COHb concentrations rapidly decreased at 5 min after the HOS administration; however, the PaO2 and SaO2 in rats treated with HOS increased significantly 5 min after the HOS administration. The S100β concentrations, which increased significantly after CO poisoning, increased at a much slower rate in the rats treated with HOS (HOS group compared with the rats treated with O2 inhalation (O2 group. The escape latency in the place navigation test was shortened after CO poisoning on days 11-15 and days 26-30, and the swimming time in quadrant 4 in the spatial probe test on days 15 and 30 after CO poisoning was prolonged in the rats treated with HOS injection compared with the rats treated with oxygen inhalation or normal saline injection. The neuronal degeneration in the HOS group was alleviated than that in the CO or O2 group. CONCLUSION: HOS efficiently alleviates the brain damage in acute CO-poisoned rats and thus may serve as a new way to treat human patients with CO poisoning in clinical practice.

Carbon monoxide poisoning in Beirut, Lebanon: Patient′s characteristics and exposure sources

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Mazen J El Sayed

2014-01-01

Full Text Available Background: Carbon monoxide (CO poisoning is a preventable disease. Patients present with nonspecific symptoms post CO exposure. Causal factors are well described in developed countries, but less in developing countries. Objectives: This study examined the characteristics of patients with CO poisoning treated at a tertiary care center in Beirut, Lebanon, and their association with the CO poisoning source. Materials and Methods: A retrospective chart review of all patients who presented to the Emergency Department (ED of the American University of Beirut Medical Center (AUBMC over 4-year period and for whom a carboxyhemoglobin (CO-Hb level was available. Patients with CO poisoning diagnosis were included in the study. Patients′ characteristics and their association with CO poisoning source were described. Results: Twenty-seven patients were treated for CO poisoning during the study period, 55% of whom were males. Headache was the most common presenting symptom (51.9%. Burning charcoal indoors was the most common causal factor (44.4%, whereas fire-related smoke was another causal factor. The median arterial CO-Hb level on presentation for all cases was 12.0% (interquartile range (IQR 7.3-20.2. All patients received normobaric oxygen therapy. No complications were documented in the ED. All patients were discharged from the ED with a median ED length of stay of 255 min (IQR 210-270. Young females were more likely to present with CO poisoning from burning charcoal indoors than from another cause. Conclusion: CO poisoning in Beirut, Lebanon is mainly due to charcoal burning grills used indoors and to fire-related smoke. A clinically significant association was present between gender and CO poisoning source. An opportunity for prevention is present in terms of education and increased awareness regarding CO emission sources.

Occupational carbon monoxide violations in the State of Washington, 1994-1999.

Science.gov (United States)

Lofgren, Don J

2002-07-01

Occupational exposure to carbon monoxide continues to cause a number of injuries and deaths. This study reviewed the State of Washington OSHA inspection records for occupational safety or health violations related to carbon monoxide for the time period 1994-1999 to assess the agency's efforts and further identify and characterize causative factors. Inspection data were also compared with carbon monoxide claims data from a companion study to determine if the agency was visiting the most at risk work operations. Inspections were identified by searching computerized violation texts for "carbon monoxide" or "CO." The study found 142 inspections with one or more carbon monoxide violations. Inspections were spread over 84 different 4-digit Standard Industrial Classification codes. Most inspections were initiated as a result of a complaint or other informant. Inspections were predominantly in construction and manufacturing, whereas carbon monoxide claims were mores evenly distributed between the major industries. Inspections also may have failed to find violations for some types of equipment responsible for carbon monoxide claims. Forklifts were the source of carbon monoxide most often associated with a violation, followed by compressors for respirators, auto/truck/bus, and temporary heating devices. Inspections in response to poisonings found common factors associated with lack of recognition and failure to use or maintain equipment and ventilation. Some work sites with one or more poisonings were not being inspected. Only 10 of the 51 incidents with industrial insurance claim reports of carboxyhemoglobin at or above 20 percent were inspected. Further, it was found more preventive efforts should be targeted at cold storage operations and certain warehouse and construction activities. It is proposed that more specific standards, both consensus and regulatory, would provide additional risk reduction. Reliance upon safe work practices as a primary method of control in the

False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients.

Science.gov (United States)

Weaver, Lindell K; Churchill, Susan K; Deru, Kayla; Cooney, Darryl

2013-02-01

Symptoms of carbon monoxide (CO) poisoning are non-specific. Diagnosis requires suspicion of exposure, confirmed by measuring ambient CO levels or carboxyhemoglobin (COHb). An FDA-approved pulse oximeter (Rad-57) can measure CO saturation (S(pCO)). The device accuracy has implications for clinical decision-making. From April 1 to August 15, 2008, study personnel measured S(pCO) and documented demographic factors at time of clinical blood draw, in a convenience sample of 1,363 subjects presenting to the emergency department at Intermountain Medical Center, Murray, Utah. The technician then assayed COHb. COHb and S(pCO) values were compared by subject; false positive or negative values were defined as S(pCO) at least 3 percentage points greater or less than COHb level, reported by the manufacturer to be ± 1 SD in performance. In 1,363 subjects, 613 (45%) were male, 1,141 (84%) were light-skinned, 14 in shock, 4 with CO poisoning, and 122 (9%) met the criteria for a false positive value (range 3-19 percentage points), while 247 (18%) met the criteria for a false negative value (-13 to -3 percentage points). Risks for a false positive S(pCO) reading included being female and having a lower perfusion index. Methemoglobin, body temperature, and blood pressure also appear to influence the S(pCO) accuracy. There was variability among monitors, possibly related to technician technique, as rotation of monitors among technicians was not enforced. While the Rad-57 pulse oximeter functioned within the manufacturer's specifications, clinicians using the Rad-57 should expect some S(pCO) readings to be significantly higher or lower than COHb measurements, and should not use S(pCO) to direct triage or patient management. An elevated S(pCO) could broaden the diagnosis of CO poisoning in patients with non-specific symptoms. However, a negative S(pCO) level in patients suspected of having CO poisoning should never rule out CO poisoning, and should always be confirmed by COHb. © 2013

HUBUNGAN KEPADATAN KENDARAAN DENGAN GAS KARBON MONOKSIDA UDARA AMBIEN DAN KARBOKSIHEMOGLOBIN JURU PARKIR DI JALAN GAJAH MADA DENPASAR

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I M BULDA MAHAYANA

2012-11-01

Full Text Available Gajah Mada street is the main road in Denpasar to access traditional market in Badung and Kumbasari Market. It iscrowded street with many vehicles pass through it. As a result, this could increase the level of emission gas such asambient monoxide carbon gas which could affect the concentration of carboxyhemoglobin, exposure time and subjectivecomplaints of sample.his was a cross sectional study of 12 parking man. Data was mainly collected from measurements including thedensity of vehicles, vehicles type, oil fuel type, vehicle age, ambient monoxide carbon gas, carboxyhaemoglobin,exposure time and subjective complaints of sample.The study found that the average of vehicle density mean per day was 91.338 unit or 3.805,8 unit per hour (veryhigh. The biggest type of vehicle percentage was motorbike 81%, followed by vehicles using premium fuel 93,7%. Theage of vehicles below 10 years was 55%. The mean of monoxide carbon gases concentration was 585,96 ?g/m³ per day(mean. The mean of weather situation including humidity was 82,7%, temperature 27,6ºC, eastward wind direction, faircloudy an wind speed about 1,76 m/second. The average of carboxyhaemoglobin concentration in 12 parking man was3.8% (very low. The mean of exposure time was 125 minutes. It was noted that there were 9 samples (75% withcomplaints and 3 samples (25% without any complaints.The study concluded that the highest numbers or vehicle density it is very high categories. Monoxide carbon gasconcentration it is mean categories and was under threshold limit value. The highest numbers or vehicle density and Monoxide carbon gas concentration between 14.00-16.00 pm and. There was a significant correlation between vehicledensity and ambient monoxide carbon gas. The measurement of carboxyhaemoglobin concentration it is very lowcategories. It also found that the exposure time correlated with the level carboxyhaemoglobin of parking mansignificantly.It is suggested that the Government of Denpasar

Differential exposure and acute health impacts of inhaled solid-fuel emissions from rudimentary and advanced cookstoves in female CD-1 mice.

Science.gov (United States)

Gibbs-Flournoy, Eugene A; Gilmour, M Ian; Higuchi, Mark; Jetter, James; George, Ingrid; Copeland, Lisa; Harrison, Randy; Moser, Virginia C; Dye, Janice A

2018-02-01

There is an urgent need to provide access to cleaner end user energy technologies for the nearly 40% of the world's population who currently depend on rudimentary cooking and heating systems. Advanced cookstoves (CS) are designed to cut emissions and solid-fuel consumption, thus reducing adverse human health and environmental impacts. We hypothesized that, compared to a traditional (Tier 0) three-stone (3-S) fire, acute inhalation of solid-fuel emissions from advanced natural-draft (ND; Tier 2) or forced-draft (FD; Tier 3) stoves would reduce exposure biomarkers and lessen pulmonary and innate immune system health effects in exposed mice. Across two simulated cooking cycles (duration ~ 3h), emitted particulate mass concentrations were reduced 80% and 62% by FD and ND stoves, respectively, compared to the 3-S fire; with corresponding decreases in particles visible within murine alveolar macrophages. Emitted carbon monoxide was reduced ~ 90% and ~ 60%, respectively. Only 3-S-fire-exposed mice had increased carboxyhemoglobin levels. Emitted volatile organic compounds were FD ≪ 3-S-fire ≤ ND stove; increased expression of genes involved in xenobiotic metabolism (COX-2, NQO1, CYP1a1) was detected only in ND- and 3-S-fire-exposed mice. Diminished macrophage phagocytosis was observed in the ND group. Lung glutathione was significantly depleted across all CS groups, however the FD group had the most severe, ongoing oxidative stress. These results are consistent with reports associating exposure to solid fuel stove emissions with modulation of the innate immune system and increased susceptibility to infection. Lower respiratory infections continue to be a leading cause of death in low-income economies. Notably, 3-S-fire-exposed mice were the only group to develop acute lung injury, possibly because they inhaled the highest concentrations of hazardous air toxicants (e.g., 1,3-butadiene, toluene, benzene, acrolein) in association with the greatest number of particles, and

Carbon Monoxide (CO Released from Tricarbonyldichlororuthenium (II Dimer (CORM-2 in Gastroprotection against Experimental Ethanol-Induced Gastric Damage.

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Katarzyna Magierowska

Full Text Available The physiological gaseous molecule, carbon monoxide (CO becomes a subject of extensive investigation due to its vasoactive activity throughout the body but its role in gastroprotection has been little investigated. We determined the mechanism of CO released from its donor tricarbonyldichlororuthenium (II dimer (CORM-2 in protection of gastric mucosa against 75% ethanol-induced injury. Rats were pretreated with CORM-2 30 min prior to 75% ethanol with or without 1 non-selective (indomethacin or selective cyclooxygenase (COX-1 (SC-560 and COX-2 (celecoxib inhibitors, 2 nitric oxide (NO synthase inhibitor L-NNA, 3 ODQ, a soluble guanylyl cyclase (sGC inhibitor, hemin, a heme oxygenase (HO-1 inductor or zinc protoporphyrin IX (ZnPPIX, an inhibitor of HO-1 activity. The CO content in gastric mucosa and carboxyhemoglobin (COHb level in blood was analyzed by gas chromatography. The gastric mucosal mRNA expression for HO-1, COX-1, COX-2, iNOS, IL-4, IL-1β was analyzed by real-time PCR while HO-1, HO-2 and Nrf2 protein expression was determined by Western Blot. Pretreatment with CORM-2 (0.5-10 mg/kg dose-dependently attenuated ethanol-induced lesions and raised gastric blood flow (GBF but large dose of 100 mg/kg was ineffective. CORM-2 (5 mg/kg and 50 mg/kg i.g. significantly increased gastric mucosal CO content and whole blood COHb level. CORM-2-induced protection was reversed by indomethacin, SC-560 and significantly attenuated by celecoxib, ODQ and L-NNA. Hemin significantly reduced ethanol damage and raised GBF while ZnPPIX which exacerbated ethanol-induced injury inhibited CORM-2- and hemin-induced gastroprotection and the accompanying rise in GBF. CORM-2 significantly increased gastric mucosal HO-1 mRNA expression and decreased mRNA expression for iNOS, IL-1β, COX-1 and COX-2 but failed to affect HO-1 and Nrf2 protein expression decreased by ethanol. We conclude that CORM-2 released CO exerts gastroprotection against ethanol-induced gastric

Daño al ADN en mujeres expuestas al humo de la leña en Chiapas, México DNA damage in women exposed to firewod fuel smoke , in Chiapas, México

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Crispín Herrera-Portugal

2009-12-01

Full Text Available Actualmente alrededor de la cuarta parte de la población mexicana, entre 25 y 28 millones de habitantes, cocina con leña, Sin embargo, el humo de la leña contiene una amplia gama de sustancias tóxicas, entre ellas el monóxido de carbono (CO cuyo impacto en la salud de la población rural debe ser estudiado. Por esto, el potencial daño al ADN asociado con la exposición a CO de 30 mujeres que cocinaban con leña en Chiapas, México, fue evaluado por el ensayo cometa. Los resultados se compararon con 30 controles comparables en edad y condiciones socioeconómicas, quienes cocinaban con gas licuado de petróleo (GLP. Se obtuvieron muestras de sangre total para medir carboxihemoglobina (COHb y llevar a cabo el ensayo cometa. Se encontró diferencia significativa (PCurrently, about a quarter of the Mexican population, between 25 and 28 million people, cook with firewood. However, wood smoke contains a wide range of toxic substances, including carbon monoxide (CO whose impact on health of the rural population should be studied. Therefore, the potential DNA damage associated with the exposition to CO of 30 women who cooked with wood in Chiapas, Mexico, was assessed using Comet Assay. Results were compared with 30 controls of similar age and socioeconomic status, who cooked with liquefied petroleum gas (LPG. We obtained whole blood samples to measure carboxyhemoglobin (% COHb and perform the comet assay. There was a significant difference (P <0.001 in the percentages of COHb between women who cooked with wood (mean= 6.6% and those who did it with LPG (mean=1.8% being 3.6 times higher in the former compared with the latter. There was a significant difference in comet tail length between the two groups examined (mean 18.5 +/- 4.21 versus 5.97 +/- 1.0 μm, P <0.001 and tail moment (mean 4.55 +/- 1.5 versus 1.5 +/- 0.40, P <0.001. The results of this study strongly suggest that exposure to carbon monoxide and compounds present in wood smoke can cause

Experimental model of smoking and simulation of reflux with acid and pepsin in rats Modelo experimental de tabagismo e simulação de refluxo com ácido e pepsina em ratos

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José Hélio Zen Junior

2012-01-01

Full Text Available PURPOSE: To develop experimental models to evaluate the effects of hydrochloric acid associated with the pepsin instilled in the mucosa of the upper esophagus and the esophagogastric junction of young male rats Wistar, simulating injury caused by gastroesophageal reflux on the mucosa of aero-digestive tract in humans as well as the action of the risk exposure of mucosa to cigarette smoke. METHODS: Fifty young male Wistar rats divided in 5 groups with 10 animals each one, respectively simulating pharyngo-laryngeal reflux and gastroesophageal reflux, pharyngo-laryngeal reflux and smoking, smoking only, gastroesophageal reflux and control group. RESULTS: The histopathologic studies no recorded neoplasias, only mild changes and no significant alterations. The hemo-oximetry (carboxyhemoglobin and methemoglobim and CO2 concentration confirm that the animals were submitted to high intensity of exposure to carcinogens in tobacco and its derivatives. CONCLUSION: The experimental models were highly efficient, practical, easy to use and economical and can be employed in other similar studies to determine the harmful effects by smoking and reflux.OBJETIVO: Desenvolver modelos experimentais para avaliar os efeitos do ácido clorídrico associado a pepsina, instilados na mucosa da parte superior do esôfago e da junção esofagogástrica de jovens ratos Wistar, simulando lesão causada por refluxo gastroesofágico na mucosa do trato aero-digestivo em humanos, bem como a ação da exposição ao risco de mucosa, como a fumaça de cigarro. MÉTODOS: Cinqüenta jovens ratos Wistar divididos em cinco grupos com 10 animais cada um, respectivamente, simulando o refluxo faringo-laríngeo e refluxo gastroesofágico, refluxo faringo-laríngeo e tabagismo, tabagismo só, refluxo gastroesofágico e grupo controle. RESULTADOS: os estudos histopatológicos não registraram neoplasias, apenas leves alterações e não significativas. O hemo-oximetria (carboxiemoglobina e

Evaluating Nicotine Levels Selection and Patterns of Electronic Cigarette use in a Group of “Vapers” Who Had Achieved Complete Substitution of Smoking

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Konstantinos E. Farsalinos

2013-01-01

Full Text Available Background Electronic cigarettes (ECs are alternative-to-smoking nicotine delivery devices; consumers (commonly called vapers use them in order to reduce or completely substitute smoking. The European Commission has released a proposal for a new Tobacco Product Directive that might reduce availability of nicotine-containing products, including ECs. In this study, the EC use patterns in subjects who have completely substituted smoking with EC use were examined by personal interviews. The study focused on nicotine levels used in order to achieve smoking cessation, reported benefits, associated side effects, and estimation of EC dependence compared with smoking. Methods Participants were 111 subjects who had completely substituted smoking with EC use for at least 1 month. Smoking abstinence was validated by measuring blood carboxyhemoglobin levels. Nicotine levels at initiation of EC use, at time of smoking cessation, and at time of interview were recorded. Dependence potential was assessed by asking the first question of the Fagerström Test for Cigarette Dependence (time until smoking the first cigarette and until first use of EC in the morning and questions about perceived past dependence on tobacco cigarettes and present dependence on EC. Results Forty-two percent of participants reported quitting smoking during the first month of EC use. Liquids with nicotine concentration >15 mg/mL were used by 74% of users at initiation of EC use, while 16.2% had to increase the initial nicotine levels in order to achieve complete smoking abstinence. Seventy-two participants (64.9% reported that from the time of smoking cessation to the time of the interview (8 months median duration of EC use they reduced the nicotine concentration they were consuming; however, only 12% of the total sample was using ≤5 mg/mL nicotine concentration at the time of the interview. Side effects were mild and temporary. The vast majority of participants reported better exercise

Hyperventilation with Maintenance of Isocapnia. An "Old New" Method in Carbon Monoxide Intoxication.

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Jacek Sein Anand

Full Text Available Exposure to carbon monoxide (CO is among the most common causes of acute and chronic poisonings worldwide. The crucial point of treatment of such acute poisonings is to eliminate CO from the body as fast as possible. There are currently two approaches to the management of the CO intoxication: hyperbaric oxygen therapy (HOT and normobaric oxygen therapy (NOT. HOT is highly effective and capable of achieving the CO elimination half-time (T½ as low as 15 minutes. Unfortunately this method is expensive and not always readily available. The elimination of CO with the use of NOT (T½~70 min is slower, but treatment can be started even on the site of the exposure and continued while the patient is transported to a hospital. The aim of the study was to evaluate the effectiveness of a method using therapeutic hyperventilation with maintenance of isocapnia (IH in the elimination of CO in volunteers exposed to CO and to compare selected gasometric and respiratory parameters during IH with the values obtained during hyperventilation with pure oxygen ("non-isocapnic hyperventilation"-NIH.The study involved 13 healthy, chronically-smoking volunteers. Each of them participated in two independent hyperventilation tests: IH and NIH. The levels of carboxyhemoglobin (COHb and selected gasometric, cardiac and respiratory parameters were measured at 0, 10 and 20 minutes during both tests. Among 13 volunteers (8 women and 5 men the initial COHb level was 5.0±1.5% (mean±SD before the IH tests and 5.1±1.9% before the NIH tests (p>0.05. After 20 minutes of the procedures the mean COHb level was 2.9±0.9% for IH and 3.6±1.2% for NIH (p<0.01. The T½ of COHb was 29.6±12.2 min and 47.3±19.2 min respectively (p<0.01. After 10 minutes of NIH respiratory alkalosis was noted in 11 participants (84.6%. Such problem was not seen during the IH procedures. No serious adverse effects were recorded during either IH or NIH. Mild symptoms such as: dyspnea, headache and

Interferência da coloração de esmaltes de unha e do tempo na oximetria de pulso em voluntários sadios Interference of nail polish colors and time on pulse oximetry in healthy volunteers

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Mara Harumi Miyake

2003-12-01

Full Text Available INTRODUÇÃO: A oximetria de pulso é um método não invasivo de mensuração da saturação periférica da oxiemoglobina (SpO2. É freqüentemente utilizado em unidades de emergência, de terapia intensiva e em centro cirúrgico. A leitura da oximetria de pulso tem acurácia limitada na presença de metaemoglobina, carboxiemoglobina, anemia, vasoconstrição periférica, esmalte de unha, luz fluorescente e movimentação. OBJETIVO: Avaliar a interferência da coloração de esmalte de unha e do tempo sobre a SpO2 em indivíduos sadios. MÉTODO: Participaram do estudo 61 voluntárias sadias, com idades entre 18 e 32 anos. Foi avaliada SpO2 nas seguintes colorações de esmaltes: base (dedo mínimo, rosa claro (dedo anular, rosa claro com cintilante (dedo médio e vermelha (polegar. O indicador não recebeu esmalte. Foi analisado o tempo para cada coloração de esmalte, a cada minuto até completar cinco minutos. RESULTADOS: Quando comparadas as medidas da SpO2 com o controle, as colorações base (p = 0,56, rosa claro (p = 0,56 e rosa claro com cintilante (p = 0,37 não apresentaram diferença estatisticamente significante. A SpO2 apresentou variação significante na cor vermelha (p BACKGROUND: Pulse oximetry is a noninvasive method to measure the saturation of peripheral oxyhaemoglobin (SpO2. It's usually used in emergency, intensive care and operating room units. Pulse oximeter readings have limited accuracy in the presence of methemoglobin, carboxyhemoglobin, anaemia, peripheral vasoconstriction, nail polish, fluorescent light, and motion. OBJECTIVES: To evaluate the interferences of the color of nail polishes and time on SpO2 in healthy individuals. METHODS: Sixty-one healthy female volunteers, ages ranging from 18 to 32 years. The nail polish colors used to evaluate SpO2 were: base coat on the little finger, light pink on the ring finger, sparkling light pink on the medium finger and red on the thumb. The index finger was used as control

Evaluación de la exposición al monóxido de carbono en vendedores de quioscos. Valencia, Venezuela Evaluation of exposure to carbon monoxide among kiosk vendors in Valencia, Venezuela

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Maritza Rojas

2001-04-01

Full Text Available Objetivos. Estudiar la intensidad de la exposición al monóxido de carbono (CO, los factores contribuyentes a esta exposición y sus potenciales efectos sobre la salud en vendedores de quioscos ubicados en una avenida de alta densidad de tránsito en Valencia, Venezuela. Métodos. Se midió la concentración de CO en el aire (CO-aire en 16 quioscos y se determinó la concentración sanguínea de carboxihemoglobina (COHb-S en los individuos que trabajaban en esos quioscos y en un grupo de control formado por docentes, estudiantes y obreros de la Universidad Simón Rodríguez, ubicada en una zona montañosa, apartada, sin contaminación ambiental aparente. Resultados. En el grupo expuesto no se encontró correlación entre las concentraciones de COHb-S y de CO-aire. La COHb-S media del grupo expuesto (2,9% fue significativamente superior a la del grupo de control (1,6% y a la concentración permisible según el método analítico empleado (Objective. To study the level of exposure to carbon monoxide (CO, factors contributing to this exposure, and the exposure's potential effects on the health of vendors who have kiosks located on an avenue with heavy vehicular traffic in the city of Valencia, Venezuela. Methods. We measured the concentration of CO in the air (CO-air in 16 kiosks in Valencia and also determined the concentration of carboxyhemoglobin (COHb in the blood of 20 individuals who worked in those kiosks. We also determined the COHb concentrations in a control group made up of 23 professors, students, and workers from Simón Rodríguez University, which is in a town some 120 km from Valencia, in a remote mountainous area without noticeable pollution. Results. In seven of the Valencia kiosks (43.7% the permissible CO-air limits were exceeded. Among the vendors experimental group there was no correlation between the concentrations of CO-air and of COHb. The COHb average for the experimental group (2.9% was significantly higher than that of

Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance.

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Vearrier, David; Greenberg, Michael I

2011-08-01

effect of high altitude is acute mountain sickness, while the most severe adverse neurological effect is high-altitude cerebral edema. Poor sleep quality and sleep-disordered breathing may contribute to daytime sleepiness and impaired cognitive performance that could potentially result in workplace injuries, particularly in miners who are already at increased risk of suffering unintentional workplace injuries. OPHTHALMOLOGICAL EFFECTS: Adverse ophthalmological effects include increased exposure to ultraviolet light and xerophthalmia, which may be further exacerbated by occupational dust exposure. RENAL EFFECTS: High altitude is associated with a protective effect in patients with renal disease, although it is unknown how this would affect miners with a history of chronic renal disease from exposure to silica and other renal toxicants. HEMATOLOGICAL EFFECTS: Advanced age increases the risk of erythrocytosis and chronic mountain sickness in miners. Thrombotic and thromboembolic events are also more common at high altitude. MUSCULOSKELETAL EFFECTS: Miners are at increased risk for low back pain due to occupational factors, and the easy fatigue at altitude has been reported to further predispose workers to this disorder. TOXIC EXPOSURES: Diesel emissions at altitude contain more carbon monoxide due to increased incomplete combustion of fuel. In addition, a given partial pressure of carbon monoxide at altitude will result in a larger percentage of carboxyhemoglobin at altitude. Miners with a diagnosis of chronic obstructive pulmonary disease may be at higher risk for morbidity from exposure to diesel exhaust at altitude. Both mining and work at altitude have independently been associated with a number of adverse health effects, although the combined effect of mining activities and high altitude has not been adequately studied. Careful selection of workers, appropriate acclimatization, and limited on-site surveillance can help control most health risks. Further research is

Wpływ terapii BEMER na wybrane wskaźniki krwi w ramach procesu odnowy biologicznej po wysiłku wytrzymałościowym. Studium przypadku = Effect of BEMER therapy on selected indicators of blood in the process of wellness after exercise endurance. Case study

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Mirosław Mrozkowiak

2015-04-01

-6 dekadzie życia może być uzasadnione i jako przygotowanie do wysiłku fizycznego.     Abstract   The principal vesels are forming capillary microcirculation. A single capillary has a diameter of about 6 pm, the total cross sectional area of the capillary is about 3000 cm2. For every cubic millimeter of the human body is an average of 600 capillaries. BEMR therapy system using the complex or complement excellent basic physiological processes angiokinesis microcirculation bringing nutrients and oxygen to muscle cells. With specific modulation biorhythmical synergistic effect is achieved also into primary and secondary, slightly larger vessels. Materials and methods. Tested man pursuing a healthy lifestyle surrendered twice selected indicators measure the blood and the vascular system: after exercise endurance during physiological restitution and renewal BEMER assisted therapy. The obtained results. The most significant changes in selected indicators of blood after endurance exercise was observed in the total amount of hemoglobin smallest hydrocarbyl ion concentration. Significant changes occurred during early recovery in the indicators: partial pressure of oxygen (PO2, arterial oxygen saturation (SO2 (c, oxyhemoglobin (O2Hb, carboxyhemoglobin (HbCO, methemoglobin (MeHb and hydroxyhemoglobin (HHB. Conclusions. Methodology and profile BEMER signal variation affects the size of the selected features of the blood. BEMER pacing in rejuvenating the efforts of strength in men in 5-6 decade of life may be justified, and in preparation for exercise.

Zatrucie tlenkiem węgla – drogi narażenia, obraz kliniczny, metody leczenia = Carbon monoxide poisoning, routes of exposure, clinical manifestation, treatment

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Magdalena Sowa

2015-04-01

�owa kluczowe: tlenek węgla, zatrucie, hipoksja.   Abstract   Introduction: Carbon monoxide (CO is a colorless, odorless, non-irritating and toxic gas, undetectable by the sense organs. CO is a product of incomplete combustion of substances containing hydrocarbon products (industrial gas, coal, wood. Carbon monoxide is one of the most common causes of poisoning inhalation in the world. Aim of the study: The aim of this study was to analyze the routes of exposure, clinical manifestation and treatment of carbon monoxide poisoning. Brief overview of the state of knowledge: The toxicity of carbon monoxide is strongly associated with its high affinity for hemoglobin (approximately 200 times greater than the oxygen. The heart and central nervous system (CNS are the most vulnerable to CO. Pathomechanism of action involves binding of carbon monoxide with iron atom in the heme molecule to form a compound called carboxyhemoglobin (COHb. Inhaling carbon monoxide-rich air may cause anoxia. The oxidative metabolic processes are inhibited. Accumulation of acidic metabolites cause the enlargement of the cerebral arteries and consequently hyperemia of the brain. Summary: The amount of carbon monoxide poisoning in Poland is higher than in other European countries. Significant decrease mortality for carbon monoxide poisoning has observed over the last few years. Thousands of patients who lose their health and  their lives, should cause the attention to the effectiveness of preventive measures.   Keywords: carbon monoxide, poisoning, hypoxia.