Carbon monoxide poisoning

According to our paper in this issue, carbon monoxide (CO) poisoning is infrequently reported in Northern India. They are very fortunate. Perhaps, their buildings are better ventilated than ours. CO poisoning is common in Britain, and has killed many young people camping in tents, canal boats and caravans, and those using charcoal burners to cook in their shelter who do not extinguish the burner properly before settling in for the night. Faulty but fashionable wood burning stoves are causing poisoning and deaths in some of our modern homes, ¹ and CO poisoning is also a frequent cause of death in fires. Excluding the cases where CO poisoning was used as a method of suicide, with a hose from a vehicle exhaust into the vehicle, it is a common enough occurrence in Britain for several ‘no win no fee’ personal injury solicitors to advertise publicly for cases in order to benefit from them.

Numbers of deaths in Britain reported by the National Health Service vary between 40 and 50 a year. ² The onset of poisoning may be gradual or acute. The symptoms include:

Headache

These all mimic influenza, but CO poisoning does not induce fever. The onset of CO poisoning is stealthy, and victims may not notice anything until they lapse into coma and die. ³

The mechanism of the poisoning is the replacement of normal haemoglobin, essential to carry oxygen from the lungs to all the tissues of the body, with carboxyhaemoglobin. This latter is such a stable compound that it is unable to attach to molecules of oxygen and carry them to where they are needed.

CO is released by improperly installed appliances such as ovens, heaters and boilers. Blocked ventilation is a common factor, and often occurs in well insulated, energy efficient modern houses. Using adequate ventilation is likely to prevent this poisoning even in the most threatening situations. It will also allow the complete combustion of carbon products to carbon dioxide, which is a relatively inert and harmless gas.

A useful warning sign is when others in the household or workplace become unwell with the symptoms mentioned above. Some people are more sensitive than others, such as those with heart or lung disease.

Treatment with continuous pure oxygen therapy can be effective, but the patient may be left with permanent heart or brain damage. Prevention is better than cure!

Many aspects of CO poisoning are well illustrated in a case that occurred in October 2006. A family of four, two adults and their two children aged six and seven, went to Corfu for a half-term holiday. ⁴

They stayed in a suite that had an adjoining outhouse within which was a boiler that had been very badly installed, and it did not have a flue to the outside.

A chambermaid entered the bedroom to find the two parents unconscious and the two children dead. The room had become available at short notice because the previous guests had been admitted to hospital with unexplained illness.

It was later established that all the illnesses and both deaths were due to CO poisoning from the improperly installed gas heater.

Three members of the hotel staff were found guilty of manslaughter and sentenced to seven years’ imprisonment each. They were the manager, the hotel engineer and the hotel electrician. To date, they have not served any sentence. ⁵