Sample records for carboxyhemoglobin

  1. 21 CFR 864.7425 - Carboxyhemoglobin assay. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Carboxyhemoglobin assay. 864.7425 Section 864.7425 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... assay. (a) Identification. A carboxyhemoglobin assay is a device used to determine the...

  2. Relation between workplace accidents and the levels of carboxyhemoglobin in motorcycle taxi drivers

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    Luiz Almeida da Silva


    Full Text Available OBJECTIVE: to investigate the relation between workplace accidents and the levels of carboxyhemoglobin found in motorcycle taxi drivers. METHOD: correlational, quantitative study involving 111 workers and data obtained in July 2012 through a questionnaire to characterize the participants and blood collection to measure carboxyhemoglobin levels. RESULT: 28.8% had suffered workplace accidents; 27.6% had fractured the lower limbs and significant symptoms of carbon monoxide exposure were verified in smokers. The carboxyhemoglobin levels were higher among smokers and victims of workplace accidents. CONCLUSION: motorcycle taxi drivers had increased levels of carboxyhemoglobin, possibly due to the exposure to carbon monoxide; these levels are also increased among smokers and victims of workplace accidents. The study provides advances in the knowledge about occupational health and environmental science, and also shows that carboxyhemoglobin can be an indicator of exposure to environmental pollutants for those working outdoors, which can be related to workplace accidents.

  3. Inaccurate pulse CO-oximetry of carboxyhemoglobin due to digital clubbing: case report. (United States)

    Harlan, Nicole; Weaver, Lindell K; Deru, Kayla


    Newer pulse CO-oximeters provide a non-invasive and quick means of measuring oxyhemoglobin, carboxyhemoglobin and methemoglobin. Clubbing has been reported to cause inaccuracy in pulse oximeters. We present a case of inaccurate carboxy-hemoglobin measurement by pulse CO-oximetry due to digital clubbing. An 18-year-old man with a history of cystic fibrosis presented after a suicide attempt by inhalation of exhaust. At the initial emergency department evaluation, his blood carboxyhemoglobin was 33%. He was intubated, placed on 100% oxygen and transferred to our facility. Upon arrival, we placed three different pulse CO-oximeters on different fingers and toes. Carboxyhemoglobin levels measured by these meters ranged from 9%-11%. A venous blood gas drawn on arrival showed a carboxyhemoglobin level of 2.3% after four hours on 100% oxygen by endotracheal tube. Thirty minutes later, we checked arterial blood gas, which revealed a COHb level of 0.9%. Again, non-invasive carboxyhemoglobin measurements read 10%. The patient was treated with hyperbaric oxygen for carbon monoxide poisoning. This case suggests that non-invasive measurements of carboxyhemoglobin should be correlated with the clinic history and with an arterial or venous blood gas oximetry analysis. PMID:27000014

  4. Carboxyhemoglobin and methemoglobin levels in residents living in industrial and nonindustrial communities

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    Woebkenberg, N.R.; Mostardi, R.A.; Ely, D.L.; Worstell, D.


    Carboxyhemoglobin and methemoglobin concentrations were compared in residents living in an industrial (Cleveland, Ohio) and a nonindustrial community (Elyria, Ohio). Carboxyhemoglobin levels were significantly higher among both male and female smokers and nonsmokers in Cleveland as compared to their counterparts in Elyria. Male smokers at both sites had significantly higher carboxyhemoglobin values than did the females. Methemoglobin levels were significantly higher in the nonindustrial site for all breakdowns even though ambient NO/sub 2/ and NO/sub 3/ levels were higher in the industrial site. The high methemoglobin levels are attributed to the higher nitrate levels in the drinking water in the nonindustrial city. In the industrial city, both male and female smokers had significantly higher methemoglobin values than nonsmokers. These differences were not found in the nonindustrial site. It is suggested that methemoglobin has physiological importance and in combination with carboxyhemoglobin elevated values could be a health factor.

  5. Relation of Whole Blood Carboxyhemoglobin Concentration to Ambient Carbon Monoxide Exposure Estimated Using Regression


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


    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 mon...

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


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


    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...

  7. Utility of the Measurement of Carboxyhemoglobin Level at the Site of Acute Carbon Monoxide Poisoning in Rural Areas. (United States)

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


    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 observed. Method. The subjects included patients treated for acute carbon monoxide poisoning in whom a medical emergency team was able to measure the carboxyhemoglobin level at the site of poisoning. We examined the relationship between the carboxyhemoglobin level at the site of poisoning and carbon monoxide exposure time and the relationships between the arterial blood carboxyhemoglobin level and carbon monoxide exposure time. Results. A total of 10 patients met the above criteria. The carboxyhemoglobin levels at the site of poisoning were significantly and positively correlated with the exposure time (rs = 0.710, p = 0.021), but the arterial blood carboxyhemoglobin levels were not correlated with the exposure time. Conclusion. In rural areas, the carboxyhemoglobin level measured at the site of carbon monoxide poisoning correlated with the exposure time. PMID:27239377

  8. Tetramer-dimer dissociation of carboxyhemoglobin in the absence of dithionite.


    Sawicki, C A; Gibson, Q H


    The generally accepted value for the tetramer-dimer dissociation constant KL4,2 of carboxyhemoglobin in pH 7.0 phosphate buffer lies in the range 1--2 micrometers. Previous determinations of the quantity have generally involved addition of dithionite to samples to exclude oxygen. We report flash photolysis experiments on carboxyhemoglobin in the absence of dithionite which suggest that KL4,2 is 0.2 +/- 0.05 micrometer. Addition of dithionite to our samples resulted in an order of magnitude in...

  9. Significance of the carboxyhemoglobin level for out-of-hospital cardiopulmonary arrest

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    Youichi Yanagawa


    Full Text Available Background: At low concentrations, carbon monoxide (CO can confer cyto and tissue-protective effects, such as endogenous Heme oxygenase 1 expression, which has antioxidative, anti-inflammatory, antiproliferative, and antiapoptotic effects. The level of carboxyhemoglobin in the blood is an indicator of the endogenous production of CO and inhaled CO. Aim of study: To investigate the significance of the value of carboxyhemoglobin for out-of-hospital (OH cardiopulmonary arrest (CPA. Materials and Methods: This study involved a medical chart review of cases treated from January to December 2005. The inclusion criteria included a patient who was transported to this department due to an OH CPA. The exclusion criteria included a patient who did not undergo blood gas analysis on arrival and who experienced CPA due to acute carbon monoxide intoxication. The subjects were divided into two groups based on their final outcome of either survival or non-survival. Results: There was no significant difference associated with the sex, age, frequency of witness collapse, bystander cardiopulmonary arrest, electrocardiogram at scene, cause of CPA, value of PCO 2 , HCO3 - , and methemoglobin. The frequency of OH return of spontaneous circulation and the value of pH, PO 2 , base excess, and carboxyhemoglobin in the survival group were greater than those values in the non-survival group. There were no subjects whose carboxyhemoglobin level was 0% on arrival in the survival groups. Conclusion: There appeared to be an association between higher carboxyhemoglobin levels and survival in comparison with non-survival patients.

  10. New approach to carbon monoxide poisoning treatment by laser-induced photodissociation of carboxyhemoglobin of cutaneous blood vessels (United States)

    Asimov, Mustafo M.; Asimov, Rustam M.; Gisbrecht, Alexander


    A new approach to carbon monoxide poisoning treatment based on laser-induced photodissociation of the carboxyhemoglobin is proposed. Using the simple model of laser tissue interaction the action spectra of laser radiation on carboxyhemoglobin of cutaneous blood vessels has been calculated. The results of the calculatoins indicate that there is a relatively narrow spectral range in the visible region where one could effectively irradiate carboxyhemoglobin through the tissue not in a deep distances. In the case of deeper penetration, the action spectra of laser radiation shifts toward the longer wavelength region. Despite the similarity of the carboxyhemoglobin and oxyhemoglobin action spectra, the significant difference in quantum yields of photodissociation makes possible to develop an effective method of carbon monoxide poisoning treatment.

  11. Laser-induced photodissociation of carboxyhemoglobin: An optical method for eliminating the toxic effect of carbon monoxide (United States)

    Asimov, M. M.; Asimov, R. M.; Rubinov, A. N.


    We propose and examine an optical method for eliminating the toxic effect of carbon monoxide. The developed method is based on laser-induced photodissociation of carboxyhemoglobin in blood vessels and capillaries. By numerical simulation of the interaction of laser radiation with tissue, we calculate the spectra of the action of carboxyhemoglobin and oxyhemoglobin in cutaneous blood vessels. We show that, despite the sufficiently strong overlap of the action spectra of carboxyhemoglobin and oxyhemoglobin, the substantial difference in the quantum yield values makes it possible to develop an optical method for eliminating the toxic effect of carbon monoxide. We determine the criteria for the efficiency of laser-induced photodissociation of carboxyhemoglobin under direct action on lung alveoli through the skin tissue and intravenously.

  12. Determinations of personal carbon monoxide exposure and blood carboxyhemoglobin levels in Korea. (United States)

    Chung, Y; Park, S E; Lee, K; Yanagisawa, Y; Spengler, J D


    Determinant factors for personal carbon monoxide (CO) exposures were sought in Korea, where CO poisoning has been a major public health problem due to coal briquette (Yeontan) combustion for space heating and cooking. Personal 24-hr CO exposures of 15 housewives were measured by CO passive samplers on 2 days of the week (Wednesday and Sunday). Blood samples were taken to measure carboxyhemoglobin (COHb) just after the exposure sampling. Average CO exposure and COHb level were 5.6 ppm and 2.4%, respectively. Personal CO exposures as well as COHb levels were significantly increased by the use of Yeontan, especially on a weekday. Carboxyhemoglobin levels were closely related to the time between blood collection and replacement of Yeontan: the closer the blood collection was to replace Yeontan, the higher the COHb levels were. Assuming a background COHb of 1.34%, COHb increased on average by 1.8% with a 24-hr personal CO exposure of 10 ppm. The relationship between CO exposure and COHb level was provided by simultaneous direct measurements in real environment, although a measurement of COHb at the end of exposure could not represent previous 24-hr exposure thoroughly. PMID:7871846

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

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


    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. PMID:25113835

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

    Abuchowski, A


    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. PMID:26782246

  15. Acute respiratory diseases and carboxyhemoglobin status in school children of Quito, Ecuador. (United States)

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


    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

  16. An accurate method for the determination of carboxyhemoglobin in postmortem blood using GC-TCD. (United States)

    Lewis, Russell J; Johnson, Robert D; Canfield, Dennis V


    During the investigation of aviation accidents, postmortem samples from accident victims are submitted to the FAA's Civil Aerospace Medical Institute for toxicological analysis. In order to determine if an accident victim was exposed to an in-flight/postcrash fire or faulty heating/exhaust system, the analysis of carbon monoxide (CO) is conducted. Although our laboratory predominantly uses a spectrophotometric method for the determination of carboxyhemoglobin (COHb), we consider it essential to confirm with a second technique based on a different analytical principle. Our laboratory encountered difficulties with many of our postmortem samples while employing a commonly used GC method. We believed these problems were due to elevated methemoglobin (MetHb) concentration in our specimens. MetHb does not bind CO; therefore, elevated MetHb levels will result in a loss of CO-binding capacity. Because most commonly employed GC methods determine %COHb from a ratio of unsaturated blood to CO-saturated blood, a loss of CO-binding capacity will result in an erroneously high %COHb value. Our laboratory has developed a new GC method for the determination of %COHb that incorporates sodium dithionite, which will reduce any MetHb present to Hb. Using blood controls ranging from 1% to 67% COHb, we found no statistically significant differences between %COHb results from our new GC method and our spectrophotometric method. To validate the new GC method, postmortem samples were analyzed with our existing spectrophotometric method, a GC method commonly used without reducing agent, and our new GC method with the addition of sodium dithionite. As expected, we saw errors up to and exceeding 50% when comparing the unreduced GC results with our spectrophotometric method. With our new GC procedure, the error was virtually eliminated. PMID:14987426

  17. Assessment of carboxyhemoglobin, hydrogen cyanide and methemoglobin in fire victims: a novel approach. (United States)

    Ferrari, Luis A; Giannuzzi, Leda


    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

  18. 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


    Background 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.Methods 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.Results The COHb level in group P-H((1.672±0.761)%)was significantly higher than that in group N((0.983±0.231)%)(P<0.01),and the level in group H((2.102±1.021)%)was significantly higher than groups P-H and N(P<0.01).A positive correlation was observed between the COHb concentration and the grade of HE(rs=0.357,P=0.004).There were no significant differences of COHb levels between HE patients with and without complications such as esophagogastric varices((2.302±1.072)% vs.(1.802±1.041)%,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

  19. Valores de referência para carboxiemoglobina Reference values for carboxyhemoglobin

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    Maria Elisa P. B. de Siqueira


    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.

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

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


    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. PMID:24705840

  1. Application of end-expired breath sampling to estimate carboxyhemoglobin levels in community air pollution exposure assessments (United States)

    Lambert, William E.; Colome, Steven D.; Wojciechowski, Sandra L.

    Measurement of carbon monoxide (CO) in end-expired air after breath-holding permits the estimation of blood carboxyhemoglobin (COHb) levels. Some literature suggests that the precision of the method decreases at low COHb levels. As part of a community exposure and health study, the end-expired breath method was applied to estimate COHb levels in 28 men with ischemic heart disease. Paired samples of blood and breath were collected at the beginning and end of the 24-h CO monitoring periods. The aggregate regression of all subjects' COHb on breath CO displayed high variability. However, the variability was substantially reduced for any particular subject, promoting the use of individualized blood-breath standard curves to improve the precision of COHb estimates made from breath CO. The ultimate accuracy of the blood-breath relationship could not be resolved by our data. Two major sources of error are identified. The observed person-to-person variability may be caused by physiologic factors or differences in ability to deliver an end-expired breath sample representative of alveolar air. This variation may also be due to instrumentation factors, specifically the accuracy of the IL282 CO-Oximeter at 0-3% levels. Further research into the sources of variability in the end-expired breath method is recommended. Epidemiologists using similar end-expired breath measurements to predict COHb levels should be cognizant of the magnitude and probable direction of the error in COHb estimates. This non-invasive method should continue to allow evaluation of the success of personal monitoring efforts and pharmacokinetic modeling of CO uptake in community exposure research.

  2. 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)

    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

  3. 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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    Robert Gałązkowski


    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

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

    International Nuclear Information System (INIS)

    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 H2O-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)

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

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    Yasmin Davoudi


    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.

  6. Dissolved oxygen sensing using an optical fibre long period grating coated with hemoglobin


    Partridge, Matthew; James, Stephen W.; Tatam, Ralph P.


    A long period grating fiber optic sensor coated with hemoglobin is used to detect dissolved oxygen. The sensitivity of this sensor to the ratio of dissolved carbon dioxide to dissolved oxygen is demonstrated via the conversion of carboxyhemoglobin to oxyhemoglobin on the sensor surface. The sensor shows good repeatability with a %CV of less than 1% for carboxyhemoglobin and oxyhemoglobin states with no measurable drift or hysteresis.

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

  8. 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)

    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

  9. Carbon monoxide intoxication

    Energy Technology Data Exchange (ETDEWEB)

    Kales, S.N. (Cambridge Hospital, MA (United States))


    Carbon monoxide poisoning usually results from inhalation of exhaust fumes from motor vehicles, smoke from fires or fumes from faulty heating systems. Carbon monoxide has a high affinity for hemoglobin, with which it forms carboxyhemoglobin. The resulting decrease in both oxygen-carrying capacity and oxygen release can lead to end-organ hypoxia. The clinical presentation is nonspecific. Headache, dizziness, fatigue and nausea are common in mild to moderate carbon monoxide poisoning. In more severe cases, tachycardia, tachypnea and central nervous system depression occur. When carbon monoxide intoxication is suspected, empiric treatment with 100 percent oxygen should be initiated immediately. The diagnosis is confirmed by documenting an elevated carboxyhemoglobin level. Hyperbaric oxygen therapy is recommended in patients with neurologic dysfunction, cardiac dysfunction or a history of unconsciousness. 26 refs.





    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, ve...

  11. Circulatory effects and kinetics following acute administration of carbon monoxide in a porcine model.


    Åberg, Anna-Maja; Hultin, Magnus; ABRAHAMSSON, Pernilla; Larsson, Jan Erik


    Carbon monoxide is produced in the endothelial cells and has possible vasodilator activity through three different pathways. The aim of this study was to demonstrate circulatory effects after administration of saturated carbon monoxide blood and to describe the pharmacokinetics of carbon monoxide. Six pigs were anesthetized and 150 ml blood was removed. This blood was bubbled with carbon monoxide until the carboxyhemoglobin (COHb) levels were 90-99%. A specific amount of this blood was then i...

  12. Carbon monoxide poisoning


    Dolan, Michael C.


    Carbon monoxide poisoning is a significant cause of illness and death. Its protean symptoms probably lead to a gross underestimation of its true incidence. Low levels of carbon monoxide aggravate chronic cardiopulmonary problems, and high levels are associated with cardiac arrhythmias and cerebral edema. Patients who survive acute poisoning are at risk of delayed neurologic sequelae. The measurement of carboxyhemoglobin levels does not reveal the tissue levels of carbon monoxide but is useful...

  13. Carbon Monoxide Poisoning: Some Surprising Aspects of the Equilibrium between Hemoglobin, Carbon Monoxide, and Oxygen (United States)

    Senozan, N. M.; Devore, J. A.


    Carbon monoxide poisoning and some aspects of the equilibrium between carbon monoxide, oxygen, and hemoglobin are discussed within the framework of Haldane's laws. The effect of CO on respiration is analyzed quantitatively using oxygen dissociation curves of hemoglobin in presence of carboxyhemoglobin. The analysis shows that the adverse cardiovascular consequences of chronic CO exposure are unlikely to be due to reduced O2 transport capability of hemoglobin.

  14. Recent advances in pulse oximetry


    Cannesson, Maxime; Talke, Pekka


    Conventional pulse oximetry uses two wavelengths of light (red and infrared) transmitted through a finger and a photodetector to analyze arterial hemoglobin oxygen saturation and pulse rate. Recent advances in pulse oximetry include: extended analysis of the photo plethysmographic waveform; use of multiple wavelengths of light to quantify methemoglobin, carboxyhemoglobin and total hemoglobin content in blood; and use of electronic processes to improve pulse oximeter signal processing during c...

  15. Rates of carbon monoxide elimination in males and females


    Zavorsky, Gerald S.; Tesler, Janet; Rucker, Joshua; Fedorko, Ludwik; Duffin, James; Fisher, Joseph A.


    Abstract The purpose of this study was to verify the previously reported shorter half‐time of elimination (t ½) of carbon monoxide (CO) in females compared to males. Seventeen healthy subjects (nine men) completed three sessions each, on separate days. For each session, subjects were exposed to CO to raise the carboxyhemoglobin percentage (COHb) to ~10%; then breathed in random order, either (a) 100% O2 at poikilocapnia (no CO2 added), or (b) hyperoxia while maintaining normocapnia using sequ...

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    Metin Uysalol


    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.

  18. Carbon monoxide stability in stored postmortem blood samples. (United States)

    Kunsman, G W; Presses, C L; Rodriguez, P


    Carbon monoxide (CO) poisoning remains a common cause of both suicidal and accidental deaths in the United States. As a consequence, determination of the percent carboxyhemoglobin (%COHb) level in postmortem blood is a common analysis performed in toxicology laboratories. The blood specimens analyzed are generally preserved with either EDTA or sodium fluoride. Potentially problematic scenarios that may arise in conjunction with CO analysis are a first analysis or a reanalysis requested months or years after the initial toxicology testing is completed; both raise the issue of the stability of carboxyhemoglobin in stored postmortem blood specimens. A study was conducted at the Bexar County Medical Examiner's Office to evaluate the stability of CO in blood samples collected in red-, gray-, and purple-top tubes by comparing results obtained at the time of the autopsy and after two years of storage at 3 degrees C using either an IL 282 or 682 CO-Oximeter. The results from this study suggest that carboxyhemoglobin is stable in blood specimens collected in vacutainer tubes, with or without preservative, and stored refrigerated for up to two years. PMID:11043662

  19. Heme Oxygenase-1 mRNA Expression in Egyptian Patients With Chronic Liver Disease

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    Abeer El-Sayed Abd El-Wahab


    Full Text Available Background: Chronic liver disease (CLD is a global medical problem. This disease is associated with increased hepatic oxidative stress. One of the antioxidant enzymes that protect cells against this stress is heme oxygenase-1 (HO-1.Objectives: This study aimed to investigate the mRNA expression of HO-1 in Egyptian patients with CLD and its relation to oxidative stress biomarkers.Patients and Methods: Levels of serum ferritin, carboxyhemoglobin, malondialdehyde (MDA, and erythrocyte-reduced glutathione (GSH were measured, and HO-1 mRNA expression was detected in 45 CLD patients (15 with nonalcoholic steatohepatitis [NASH], 15 with chronic hepatitis C, and 15 with liver cirrhosis and 15 healthy controls.Results: HO-1 mRNA expression was increased in patients with NASH, chronic hepatitis C, and liver cirrhosis compared to controls. The expression in cirrhotic patients was significantly higher than that in patients with NASH and chronic hepatitis C. Compared to controls, patients with NASH, chronic hepatitis C, and liver cirrhosis had higher levels of ferritin, carboxyhemoglobin, and MDA and lower levels of GSH. HO-1 mRNA expression was positively correlated with levels of carboxyhemoglobin, serum ferritin, and serum MDA and negatively correlated with levels of erythrocyte GSH in CLD patients.Conclusions: HO-1 mRNA expression was significantly increased in CLD patients, and the increase reflected the severity of the disease. The significant relationship between the increased HO-1 expression and oxidative stress biomarkers in patients with CLD suggests that HO-1 may play an important role in protecting the liver from oxidative stress-dependent damage. Therefore, induction of HO-1 could be a novel therapeutic option for CLD.

  20. Serum heavy metals and hemoglobin related compounds in Saudi Arabia firefighters

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    Al-Malki Abdulrahman L


    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.

  1. Transient Two-Dimensional Infrared Spectroscopy in a Vibrational Ladder. (United States)

    Kemlin, Vincent; Bonvalet, Adeline; Daniault, Louis; Joffre, Manuel


    We report on transient 2D Fourier transform infrared spectroscopy (2DIR) after vibrational ladder climbing induced in the CO-moiety longitudinal stretch of carboxyhemoglobin. The population distribution, spreading up to seven vibrational levels, results in a nonequilibrium 2DIR spectrum evidencing a large number of peaks that can be easily attributed to individual transitions thanks to the anharmonicity of the vibrational potential. We discuss the physical origin of the observed peaks as well as the qualitative behavior of the subsequent dynamics governed by population relaxation in the vibrational ladder. PMID:27508408

  2. Myth busting in carbon monoxide poisoning. (United States)

    Hampson, Neil B


    The evidence supporting many beliefs in medicine is based upon opinion, personal experience, hearsay, or "common knowledge." When one searches for the data supporting oft-quoted facts in medicine, they are sometimes found to be old, incorrect, or nonexistent. Such unsupported facts or beliefs can be termed myths. This minireview will summarize 4 examples of "myth busting" by the author when he has discovered widely held beliefs regarding carbon monoxide (CO) poisoning to be untrue during a 25-year career of research in the field. These include the mistaken beliefs that (1) symptoms correlate with presenting blood carboxyhemoglobin levels, (2) residents are safe from CO poisoning if their home does not contain fuel-burning appliances, (3) carboxyhemoglobin levels must be measured rapidly and on arterial blood, and (4) CO poisoning predisposes to premature long-term death from cardiac disease. In addition to providing the evidence disproving these myths, the importance of going back to the original reference when citing prior work is emphasized. PMID:26632018

  3. 11.3.Upper respiratory tract disease and bronchial asthma

    Institute of Scientific and Technical Information of China (English)


    930295 Factors influencing carboxyhemog-lobin kinetics in inhalation lung injury.WU Wenxi (吴文溪).ist Affili Hosp,Nanjing MedCoil,210029.Chin J Intern Med 1992;31 (11):689—691.Anesthetized dogs were ventilated with 1%carbon monoxide (CO) in air for 10 minutes toproduce CO poisoning and then with room air (n=5) or pure oxygen (n=5) for 3 hours as con-trol.Acute lung injury was produced by intratra-cheal injection of 0.1 N HC1 (2 ml/kg) 30 min-utes before CO poisoning in another 10 experi-mental dogs.Arterial blood gas and earboxyhe-moglobin (COHb) were monitored before andafter CO poisoning.Pharmacokinetic analysis

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

    International Nuclear Information System (INIS)

    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 32P-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

  5. Carbon Monoxide Poisoning In Children: Diagnosis And Management In The Emergency Department. (United States)

    Macnow, Theodore E; Waltzman, Mark L


    Approximately 5000 children present to the emergency department annually with unintentional carbon monoxide poisoning. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to vocalize symptoms or recognize a dangerous exposure, and newborn infants are more vulnerable to carbon monoxide poisoning because of the persistence of fetal hemoglobin. Mild carbon monoxide poisoning may present as viral symptoms in the absence of fever. While headache, nausea, and vomiting are the most common presenting symptoms in children, the most common symptom in infants is consciousness disturbance. This review discusses the limitations of routine pulse oximetry and carboxyhemoglobin measurement in determining carbon monoxide exposure, and notes effects of co-ingestions and comorbidities. Although the mainstay of treatment is 100% oxygen, the current evidence and controversies in the use of hyperbaric oxygen therapy in pediatric patients is reviewed, along with its possible benefit in preventing delayed neurologic sequelae. PMID:27547917

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

    Energy Technology Data Exchange (ETDEWEB)



    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)

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

    Energy Technology Data Exchange (ETDEWEB)



    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)

  8. An Unusual Cause of Supraventricular Tachycardia: Acute Carbon Monoxide Poisoning

    Directory of Open Access Journals (Sweden)

    Suat Zengin


    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.

  9. Acute Lung Injury Due To Carbon Monoxide Exposure

    Directory of Open Access Journals (Sweden)

    Uzkeser M et al.


    Full Text Available A 20-year-old woman, who was found unconscious in the bed by the morning, was brought to emergency department. Her carboxyhemoglobin level was 20.2%. The portable chest X-ray showed bilaterally alveolar and interstitial infiltration. Initial pO 2 /FIO 2 ratio was calculated as 119 mmHg. Acute lung injury due to carbon monoxide intoxication was considered. She was intubated and mechanical ventilation was applied. In the second day of hospitalization, a clear improvement was observed on the chest X-ray. She was discharged without any complication on the seventh day of hospitalization. Early diagnosis and treatment may prevent progression of ARDS and progression of permanent damage, and may lead to complete recovery.

  10. 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


    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.

  11. Evidence of Premeditation in Skin Messages in Suicide. (United States)

    Byard, Roger W


    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. PMID:27049851

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

    Energy Technology Data Exchange (ETDEWEB)


    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.)

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

    Energy Technology Data Exchange (ETDEWEB)


    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.)

  14. Ischemic colitis associated with acute carbon monoxide poisoning--a case report. (United States)

    Weaver, Lindell K; Deru, Kayla


    Carbon monoxide (CO) poisoning is common, but it has rarely been reported to cause ischemic colitis. In this case, a 34-year-old female with depression presented to an emergency department after a period of unconsciousness, with urinary and bowel incontinence, following exposure to car exhaust. Her carboxyhemoglobin level was 23%. She had metabolic acidosis. She was transferred to our facility for hyperbaric oxygen treatment, where she had intractable nausea/vomiting with abdominal pain and bright-red bleeding per rectum. She exhibited lower abdominal tenderness and hypoactive bowel sounds. Vital signs were: temperature 36.8 degrees C; blood pressure 137/ 86 mmHg; heart rate 114 beats/minute; respiratory rate 28 breaths/minute. The patient's electrocardiogram showed sinus tachycardia with T-wave inversions in leads I, aVL and V3-V6. The troponin I level peaked at 3.7 ng/ml. Echocardiogram showed a reduced ejection fraction of 30%-35%, with akinesis in the posterior lateral and distal anterior distributions. Computed tomography of the abdomen revealed diffuse colonic mural thickening, supporting mesenteric ischemia. Sigmoidoscopy showed edematous friable pale mucosa from rectum to distal sigmoid colon. Hyperbaric oxygen was deferred based on the patient's status. Over three days, the initial hematochezia progressed to melena and then resolved. Adenosine cardiac stress MRI was normal. She was transferred to the psychiatry service and discharged four days later. Four years later, she has no gastrointestinal, cardiac or cognitive problems. PMID:27265995

  15. Conformational changes in hemoglobin triggered by changing the iron charge

    International Nuclear Information System (INIS)

    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.

  16. Characteristics of Children with Acute Carbon Monoxide Poisoning in Ankara: A Single Centre Experience. (United States)

    Unsal Sac, Rukiye; Taşar, Medine Ayşin; Bostancı, İlknur; Şimşek, Yurda; Bilge Dallar, Yıldız


    The purpose of the study was to define characteristics of children with acute carbon monoxide poisoning. Eighty children hospitalized with acute carbon monoxide poisoning were recruited prospectively over a period of 12 months. Sociodemographic features, complaints and laboratory data were recorded. When the patient was discharged, necessary preventive measures to be taken were explained to parents. One month later, the parents were questioned during a control examination regarding the precautions that they took. The ages of the cases were between one month and 16 yr. Education levels were low in 86.2% of mothers and 52.6% of fathers. All families had low income and 48.8% did not have formal housing. The source of the acute carbon monoxide poisoning was stoves in 71.2% of cases and hot-water heaters in 28.8% of cases. Three or more people were poisoned at home in 85.1% of the cases. The most frequent symptoms of poisoning were headache and vertigo (58.8%). Median carboxyhemoglobin levels at admission to the hospital and discharge were measured as 19.5% and 1.1% (P carbon monoxide poisoning are usually from families with low socioeconomic and education levels. Education about prevention should be provided to all people who are at risk of carbon monoxide poisoning before a poisoning incident occurs. PMID:26713060

  17. 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 (United States)

    Yue, Ying; Pan, Xingfang; Zhang, Sai; Jin, Jun; Wang, Wei; Wang, Dongqiang; Han, Dexin; Wang, Guirong; Hu, Qunliang; Kang, Jingqing; Ding, Shasha; Yang, Yi; Bu, Huaien; Guo, Yi


    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. PMID:26339271

  18. Mild carbon monoxide poisoning impairs left ventricular diastolic function

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    Özgür Çiftçi


    Full Text Available Rationale: Carbon monoxide (CO poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure. Objectives: Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning. Results: The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function. Conclusions: In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvement.

  19. Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation. (United States)

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


    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. PMID:25922545

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

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    Venditti Carolina C


    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.

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

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    Simon P. Robinson


    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.

  2. Interactive effects of hypoxia, carbon monoxide and acute lung injury on oxygen transport and aerobic capacity. (United States)

    Crocker, George H; Jones, James H


    This study determined how breathing hypoxic gas, reducing circulatory capacitance for O2 by breathing CO, and impairing pulmonary gas exchange by acutely injuring the lungs interact to limit cardiopulmonary O2 delivery, O2 extraction and maximal aerobic capacity (VO2max). Five goats ran on a treadmill at VO2max following oleic-acid induced acute lung injury that impaired pulmonary gas exchange, after partial recovery or with no acute lung injury. Goats breathed normoxic or hypoxic inspired gas fractions (FIO2 0.21 or 0.12) with and without small amounts of CO to maintain carboxyhemoglobin fractions (FHbCO) of 0.02 or 0.30. With the exception of elevated FHbCO with acute lung injury (P=0.08), all combinations of hypoxia, elevated FHbCO and acute lung injury attenuated the reduction in VO2max by 15-27% compared to the sum of each treatment's individual reduction in VO2max when administered separately. Simultaneous administration of two treatments attenuated the reduction in VO2max by attenuating the decrease in cardiopulmonary O2 delivery, not synergistically increasing O2 extraction. PMID:26845454

  3. Optical noninvasive calculation of hemoglobin components concentrations and fractional oxygen saturation using a ring-scattering pulse oximeter (United States)

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


    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.

  4. Chronic carbon monoxide exposure is associated with the increases in carotid intima-media thickness and C-reactive protein level. (United States)

    Davutoglu, Vedat; Zengin, Suat; Sari, Ibrahim; Yildirim, Cuma; Al, Behcet; Yuce, Murat; Ercan, Suleyman


    Being the most common cause of death from poisoning worldwide, cardiovascular manifestations of acute carbon monoxide (CO) poisoning have been subject of various studies but current evidence about effects of chronic CO exposure on atherosclerosis is limited which is very common. We aimed to investigate association of chronic CO exposure with atherosclerosis by measuring carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (hs-CRP). Forty healthy male non-smoker indoor barbecue workers (mean age; 33.0 +/- 9.0 years) working in different restaurants for at least three years and 48 age-matched healthy men (mean age; 34.3 +/- 6.6 years) enrolled in the study. Clinical characteristics of indoor barbecue workers and control group were comparable in terms of body mass index, blood pressure, and lipid profile. However, carboxyhemoglobin (COHb) (6.4 +/- 1.5% vs. 2.0 +/- 1.1%), hs-CRP (2.7 +/- 2.0 mg/L vs. 1.1 +/- 0.8 mg/L) and CIMT (1.1 +/- 0.3 mm vs. 0.9 +/- 0.1 mm) were higher in indoor barbecue workers (p independent predictor of CIMT (beta = 0.571, p < 0.001). The increased CIMT and hs-CRP in indoor barbecue workers suggest that chronic CO exposure may increase the risk of atherosclerotic cardiovascular events. PMID:19851048

  5. Lung and systemic oxidant and antioxidant activity after graded smoke exposure in the rat. (United States)

    Lalonde, C; Picard, L; Campbell, C; Demling, R


    We wanted to determine the effect of a graded smoke inhalation on lung and systemic oxidant stress, and its relationship to physiological and histological change. Male Wistar rats were given 12 breaths of 10 ml/kg (n = 8) (group 1) or 20 ml/kg (n = 8) (group 2) tidal volume, using cotton toweling smoke through the trachea using positive pressure. Rats were monitored, then killed at 24 hr. Data were compared to controls (n = 8). Peak group 1 and group 2 carboxyhemoglobins were 22 +/- 6 and 46 +/- 6%, with a mortality prior to 24 hr of 14% and 50%, respectively. Group 1 rats showed only moderate lung dysfunction but with severe airway inflammation and edema, alveolar inflammation and atelectasis, with a decrease in PaO2 from the control of 96 +/- 4 to 72 +/- 5 torr. No increase in lung, liver, or kidney oxidant-induced lipid peroxidation, measured as malondialdehyde lung, liver, or kidney oxidant-induced lipid peroxidation, measured as malondialdehyde (MDA), or decrease in the antioxidant defenses catalase was noted. Group 2 rats demonstrated severe airways edema, alveolar atelectasis, and alveolar edema, and a PaO2 decreasing below 60 torr, corresponding with a 3-fold increase in lung tissue MDA and 35% decrease in catalase. In addition, liver and kidney tissue MDA doubled, and catalase activity decreased by 40%. Increased oxygen consumption was also demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8149511

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

    International Nuclear Information System (INIS)

    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 14C-arachidonic acid than rings from sham rats. Platelets from smoke-exposed rats synthesized more thromboxane (TXA2) from 14C-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

  7. Severe scombroid fish poisoning syndrome requiring aggressive fluid resuscitation in the emergency department: two case reports. (United States)

    Iannuzzi, M; D'Ignazio, N; Bressy, L; De Sio, A


    Scombroid fish poisoning (scombrotoxism, scombroid ichthyotoxicosis) is a food-related illness typically associated with the consumption of dark and white meat fish. Two patients presented to the emergency department. Metilprednisone 1000 mg and ranitidine 150 mg were administered initially. A large amount of crystalloids and colloids in in combination with vasoactive drugs were required to maintain normopressure. Levels of histamine and N-methylhistamine were far above the normal mean. Carboxyhemoglobin levels were also tested to exclude a superimposition of carbon monoxide intoxication. In both cases, major symptoms occurred and were treated aggressively. Early goal directed fluid therapy corrected the DO2/VO2 unbalance, due to a distributive pattern of hypovolemic impending shock, and permitted a rapid stabilisation of both patients. It is important to recognize the syndrome as an intoxication (rather than an allergic reaction) so that the source of the toxin can be identified and further cases prevented. It is also important to investigate where the fish was cooked (i.e. in an open space vs. closed space), to exclude the possibility of a concomitant carbon monoxide intoxication, which would require transfer the patient to a hospital facility equipped with a hyperbaric chamber. PMID:17115014

  8. [Atypical case of teenager fatal poisoning by butane as a result of gas for lighters inhalation against his will]. (United States)

    Celiński, Rafał; Skowronek, Rafał; Uttecht-Pudełko, Anna


    Inhalatomania with volatile organic compounds is a still present phenomenon among Polish young adolescents. Conscious, voluntary exposition on such substances may result in serious health consequences, including sudden death in the course of acute intoxication. In this paper, atypical case of death of 16-year-old teenager as a result of complications of physically forced inhalation of gas for lighters is presented. According to testimonies of witnesses, the container was placed in the mouth of victim and the gas was introduced directly to his throat. Autopsy revealed small damage of tooth with corresponding bruising of lower lip; brain and lung oedma; single bruisings in the upper respiratory tract and subpleural. Chemical-toxicological analysis of blood, brain and lung samples taken during autopsy revealed in all of them the presence of n-butan--a component of gas for lighters (the greatest in brain and lung tissues). Additionally, in blood the presence of carboxyhemoglobin (COHb) in concentration 7% was confirmed. Based on the results of analyses, acute intoxication with n-butan was estimated as a cause of death; however the key role played the information obtained during the investigation. This case shows, that deaths resulting from gas for lighters inhalation may be a consequence of forced exposition--against victim's will. So medical staff should always check, if on the body of patient there are any signs of physical constraint (the presence of bruisings in the area of viscerocranium and oral cavity, teeth damages, etc.). PMID:24167951

  9. 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)

    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

  10. 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


    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.

  11. Suicidal chemistry: combined intoxication with carbon monoxide and formic acid. (United States)

    Bakovic, Marija; Nestic, Marina; Mayer, Davor


    Herein, we present a rare case of suicidal intoxication with carbon monoxide produced via reaction of formic and sulphuric acid with additional toxic effect of formic acid. The deceased was a 22-year-old men found dead in the bathroom locked from the inside. A bucket filled with liquid was found next to him, together with an almost empty canister labeled "formic acid" and another empty unlabeled canister. The postmortem examination revealed corrosive burns of the face, neck and chest, cherry-pink livor mortis, corrosive injury to the oropharyngeal area and trachea, subpleural petechiae, 100 mL of blood in stomach and superficial erosions of stomach mucosa. Toxicology analysis revealed 30% of carboxyhemoglobin in the femoral blood and the presence of the formic acid in various samples. Quantitative analysis of formic acid was performed by measuring methyl ester derivative of formic acid by using headspace gas chromatography with flame ionization detection. The highest concentration of formic acid was measured in the lungs (0.55 g/kg), gastric content (0.39 g/L), and blood (0.28 g/L). In addition, it was established that content of the unlabeled canister had a pH value of 0.79 and contained sulphuric ions. Morphological and toxicology findings suggested that the main route of exposure to formic acid was inhalation of vapors with a possible ingestion of only small amount of liquid acid. The cause of death was determined to be combined intoxication with carbon monoxide and formic acid. PMID:26041513

  12. Toxicological assessment of a prototype e-cigaret device and three flavor formulations: a 90-day inhalation study in rats. (United States)

    Werley, Michael S; Kirkpatrick, Dan J; Oldham, Michael J; Jerome, Ann M; Langston, Timothy B; Lilly, Patrick D; Smith, Donna C; Mckinney, Willie J


    A prototype electronic cigaret device and three formulations were evaluated in a 90-day rat inhalation study followed by a 42-day recovery period. Animals were randomly assigned to groups for exposure to low-, mid- and high-dose levels of aerosols composed of vehicle (glycerin and propylene glycol mixture); vehicle and 2.0% nicotine; or vehicle, 2.0% nicotine and flavor mixture. Daily targeted aerosol total particulate matter (TPM) doses of 3.2, 9.6 and 32.0 mg/kg/day were achieved by exposure to 1 mg/L aerosol for 16, 48 and 160 min, respectively. Pre-study evaluations included indirect ophthalmoscopy, virology and bacteriological screening. Body weights, clinical observations and food consumption were monitored weekly. Plasma nicotine and cotinine and carboxyhemoglobin levels were measured at days 28 and 90. After days 28, 56 and 90, lung function measurements were obtained. Biological endpoints after 90-day exposure and 42-day recovery period included clinical pathology, urinalysis, bronchoalveolar fluid (BALF) analysis, necropsy and histopathology. Treatment-related effects following 90 days of exposure included changes in body weight, food consumption and respiratory rate. Dose-related decreases in thymus and spleen weights, and increased BALF lactate dehydrogenase, total protein, alveolar macrophages, neutrophils and lung weights were observed. Histopathology evaluations revealed sporadic increases in nasal section 1-4 epithelial hyperplasia and vacuolization. Following the recovery period, effects in the nose and BALF were persistent while other effects were resolved. The no observed effect level based upon body weight decreases is considered to be the mid-dose level for each formulation, equivalent to a daily TPM exposure dose of approximately 9.6 mg/kg/day. PMID:26787428

  13. Assessing inhalation injury in the emergency room

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    Tanizaki S


    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

  14. The usefulness of the arterial blood gas in pure carbon monoxide poisoning. (United States)

    Lebby, T I; Zalenski, R; Hryhorczuk, D O; Leikin, J B


    In a retrospective study of 49 cases of carbon monoxide (CO) intoxication presented to the University of Illinois Hospital (UIH) Emergency Department between November 1986 and April 1988, we looked for a correlation between carboxyhemoglobin (COHb) as determined by a venous sample and the pH as determined by arterial blood gas analysis. The range of COHb levels in our study was 10-64% (mean 21.8% +/- 10.2%). Smoke inhalation cases (n = 3) were excluded from our study because they did not represent pure CO intoxication. Of the remaining 46 cases, 18 had arterial blood gases drawn. In none of these 18 cases (mean COHb 24.5% +/- 12.6%) did we find a correlation between COHb levels and the pH as determined by linear regression analysis. Also, in none of the 18 cases were there any therapeutic interventions associated with the arterial blood gas result. Additionally, in none of the remaining 28 cases were any therapeutic interventions performed with regards to patients' acidosis or ventilatory status (except 100% oxygen administration. We also retrospectively reviewed records of 104 cases who presented to Cook County Hospital Emergency Department with COHb levels over 10% during the period between March 1986 and May 1988. In these cases, we found no significant correlation between COHb level and arterial pH. We therefore conclude that arterial blood gases drawn in order to determine the degree of acidosis in mild CO intoxication without respiratory distress may not be useful in guiding therapeutic intervention and need not be routinely drawn. PMID:2929122

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

    International Nuclear Information System (INIS)

    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

  16. Electrocardiographic Findings and Serum Troponin I in Carbon Monoxide Poisoned Patients

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    Scott Reza Jafarian Kerman


    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.

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

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    Mazen J El Sayed


    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.

  18. Ischemia-modified albumin levels in the prediction of acute critical neurological findings in carbon monoxide poisoning. (United States)

    Daş, Murat; Çevik, Yunsur; Erel, Özcan; Çorbacioğlu, Şeref Kerem


    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 1(st) hour and 3(rd) 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 6(th) hour were not higher compared with control individuals. The levels of IMA on admittance, and during the 1(st) hour, 3(rd) hour, and 6(th) 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. PMID:27185603

  19. Carbon Monoxide Poisonings from Forklift Use During Produce Packing Operations. (United States)

    Hirsch, Anne E; Langley, Ricky L; McDaniel, Jesse S


    In August 2013, the North Carolina Division of Public Health investigated a carbon monoxide (CO) exposure on a farm. Two employees were overcome by CO and lost consciousness while using a propane-powered forklift to load produce into a refrigerated trailer backed up to a warehouse. One employee died, and the second employee was admitted to the hospital for hyperbaric oxygen treatment. Eighteen people, ranging in age from 18 to 69 years, were potentially exposed to CO, including the two employees, a family member who discovered the employees, two bystanders who stopped to offer assistance, and 13 first responders. Thirteen people who assisted in the emergency response experienced symptoms such as headache and dizziness, and all 16 who assisted were evaluated in a local hospital emergency department and released after receiving 100% oxygen. Blood tests showed five people (the two employees, family member, and two bystanders) had elevated blood carboxyhemoglobin levels, but all first responders had levels within normal range. Firefighters measured a peak CO concentration of 2214 parts per million in the warehouse. The North Carolina Division of Occupational Safety and Health investigated and determined that the forklift, operated inside the trailer with no ventilation, was the source of the CO. Public health investigation activities included interviewing responders, obtaining ambient CO concentration measurements from the fire department, advising the local health director, reviewing medical records, and developing a line listing of exposed persons. To prevent CO poisoning, employers should consider replacing gas-powered equipment with electric equipment, which does not produce CO. PMID:26788681

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

    International Nuclear Information System (INIS)

    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

  1. Sanguinate's effect on pial arterioles in healthy rats and cerebral oxygen tension after controlled cortical impact. (United States)

    Mullah, Saad H; Abutarboush, Rania; Moon-Massat, Paula F; Saha, Biswajit K; Haque, Ashraful; Walker, Peter B; Auker, Charles R; Arnaud, Francoise G; McCarron, Richard M; Scultetus, Anke H


    Sanguinate, a polyethylene glycol-conjugated carboxyhemoglobin, was investigated for cerebral vasoactivity in healthy male Sprague-Dawley rats (Study 1) and for its ability to increase brain tissue oxygen pressure (PbtO2) after controlled cortical impact (CCI) - traumatic brain injury (TBI) (Study 2). In both studies ketamine-acepromazine anesthetized rats were ventilated with 40% O2. In Study 1, a cranial window was used to measure the diameters of medium - (50-100μm) and small-sized (volume-matched Hextend, or normal saline. In Study 2, PbtO2 was measured using a phosphorescence quenching method before TBI, 15min after TBI (T15) and then every 10min thereafter for 155min. At T15, rats received either 8mL/kg IV Sanguinate (40mL/kg/h) or no treatment (saline, 4mL/kg/h). Results showed: 1) in healthy rats, percentage changes in pial arteriole diameter were the same among the groups, 2) in TBI rats, PbtO2 decreased from 36.5±3.9mmHg to 19.8±3.0mmHg at T15 in both groups after TBI and did not recover in either group for the rest of the study, and 3) MAP increased 16±4mmHg and 36±5mmHg after Sanguinate in healthy and TBI rats, respectively, while MAP was unchanged in control groups. In conclusion, Sanguinate did not cause vasoconstriction in the cerebral pial arterioles of healthy rats but it also did not acutely increase PbtO2 when administered after TBI. Sanguinate was associated with an increase in MAP in both studies. PMID:27287870

  2. Edaravone attenuates brain damage in rats after acute CO poisoning through inhibiting apoptosis and oxidative stress. (United States)

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


    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 < 0.01). Basal expressions of HO-1 and Nrf-2 proteins were found in normal brain tissue. CO poisoning could activate HO-1/Nrf-2 pathway, start oxidative stress response. After the administration of Edaravone, the expression of HO-1 and Nrf-2 significantly increased (P < 0.01). These findings suggest that 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. Environ Toxicol 31: 372-379, 2016

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

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    Ken Iseki


    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.  

  4. Carbon monoxide poisoning in children riding in the back of pickup trucks. (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. PMID:1370334

  5. Exposure to Elevated Carbon Monoxide Levels at an Indoor Ice Arena--Wisconsin, 2014. (United States)

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


    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. PMID:26583915


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    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

  7. 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). (United States)

    Magierowska, Katarzyna; Magierowski, Marcin; Surmiak, Marcin; Adamski, Juliusz; Mazur-Bialy, Agnieszka Irena; Pajdo, Robert; Sliwowski, Zbigniew; Kwiecien, Slawomir; Brzozowski, Tomasz


    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 N(G)-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. PMID:27023525

  8. 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


    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

  9. 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


    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

  10. 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


    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.

  11. Change and role of heme oxygenase-1 in injured lungs following limb ischemia/reperfusion in rats

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    周君琳; 朱晓光; 林源; 凌亦凌; 邵新中; 张桂生


    Objective: To study the change and role of hemeoxygenase-1 (HO-1) in injured lungs following limbischemia/reperfusion in rats.Methods: A total of 96 healthy male Sprague-Dawley rats, weighing 250-300 g, were used in this study. Hind limb ischemia was made on 40 rats through clamping the infrarenal aorta for 2 hours with a microvascular clip, then limb reperfusion for 0, 4, 8,16 and 24 hours(n =8 in each time point)was performed, respectively. Other 8 rats undergoing full surgical operation including isolation of the infrarenal aorta without occlusion were taken as the sham operation group. Lung tissues were obtained from the 48animals and Northern blotting and Western blotting were employed to measure the changes of HO-1 mRNA and protein expression, respectively. Immunohistochemistry technique was used to determine the cell types responsible for HO-1 expression after limb ischemia/reperfusion. Then hind limb ischemia was made on other 12 rats through clamping the infrarenal aorta for 2 hours with a microvascular clip, among whom, 6 rats were given zinc protoporphyrin (ZnPP), an inhibitor of HO. Then limb reperfusion for 16 hours was performed on all the 12 rats.And other 12 rats underwent full surgical operation including isolation of the infrarenal aorta without occlusion,among whom, 6 rats were then given ZnPP. Then lung tissues were obtained from the 24 animals and lung injury markers, lung histology, polymorphonuclear leukocyte (PMN) count and malondialdehyde (MDA) content were detected, respectively. HO activity was determined through measuring the carboxyhemoglobin (COHb) level in artery blood with a CO-oximeter after limb ischemia/reperfusion.And the animal mortality was observed on the other 24rats.Results: Northern blotting analysis showed that HO-1mRNA increased significantly at 4 hours after reperfusion,peaked at 16 hours, and began to decrease at 24 hours. In contrast, no positive signal was observed in the sham and simple ischemia animals. Increased HO

  12. 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


    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

  13. Diagnosis and management of carbon monoxide poisoning in the emergency department. (United States)

    Nikkanen, Heikki; Skolnik, Aaron


    hemoglobin of 10.3 g/dL and a leukocyte count of 11.7 x 10(9)/L. Electrolyte results fall within the normal range, and her serum creatinine is 1.7 mg/dL. Qualitative CK-MB and troponin I tests are positive, and the sample has been sent to the STAT lab for quantitative testing. Serum carboxyhemoglobin level is 15% with normal serum pH on an arterial blood gas. An ECG reveals deep, down-sloping inferior and lateral ST-segment depressions which were not present on a routine cardiogram 1 month prior. You have many questions about this patient's care. What symptoms and physical signs need to be addressed and treated? What additional diagnostic testing should be performed? What treatment regimen is appropriate and what should be avoided? What are the risks or delayed complications from her illness? Are there special considerations for this or other patient populations? PMID:22164402

  14. 内源性一氧化碳对变应性鼻炎豚鼠诱导型一氧化氮合酶表达的影响%Influence of carbon monoxide on the expression of inducible nitric oxide synthase mRNA in guinea pigs with allergic rhinitis

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    余少卿; 章如新; 陈英剑; 燕志强; 吴革平; 王延生; 陈剑秋; 朱春生; 李跟红


    目的 制备豚鼠变应性鼻炎(allergic rhinitis,AR)动物模型,研究在AR豚鼠模型中内源性一氧化碳(carbon monoxide,CO)对诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)表达的影响.方法 24只豚鼠以随机数字表法分为4组,每组6只.第1组以生理盐水处理作为正常对照组,第2(AR组)、3、4组以卵清蛋白(ovalbumin,OVA)致敏,制成AR动物模型,第3、4组再分别以血红素氧合酶1(hemeoxygenase 1,HO-1)诱导剂氯化血红素和抑制剂锌原卟啉干预处理,分别作为HO诱导组和HO抑制组,分别测定各组豚鼠血浆中碳氧血红蛋白(carboxyhemoglobin,COHb)的百分含量(用来代表血浆中CO含量),并采用实时荧光定量反转录聚合酶链反应(RT-PCR)法测定鼻黏膜中HO-1和iNOS的相对表达量.结果 第2、3、4组豚鼠AR造模成功.血浆COHb含量(x-±s,以下同)第2组(2.27%±1.13%)高于第1组(1.08%±0.24%),差异有统计学意义(q=4.10,P<0.01);第3组(3.17%±0.68%)高于第2组,差异有统计学意义(q=3.12,P<0.05).鼻黏膜中HO-1、iNOS的相对表达量(x-±s,以下同)第2组[分别为(7.80±1.60)×10~(-3)和(5.81±0.05)×10~(-3)]高于第1组[分别为(1.96±0.71)×10~(-3)和(0.97±0.05)×10~(-3)],差异有统计学意义(q值分别为5.52、7.21,P值均<0.01),第3组[分别为(11.89±4.78)×10~(-3)和(7.42±0.70)×10~(-3)]高于第2组,差异有统计学意义(q值分别为3.86、2.22,P值均<0.05),第4组[分别为(3.82±0.98)×10~(-3)和(2.34±0.04)×10~(-3)]低于第2组,差异有统计学意义(q值分别为3.76、5.18,P值均<0.05).结论 内源性CO在AR中影响iNOS的表达.%Objective To study the impact of carbon monoxide(CO)on expression levels of inducible nitric oxide synthase(iNOS)mRNA in guinea pigs with allergic rhinitis(AR).Methods Twenty four guinea pigs were divided randomly into four study groups with 6 guinea pigs in each.The guinea pigs in the first group were treated with saline only(Group 1,the healthy