Towards the end of last year I saw a young girl in clinic with rather strange and non-specific symptoms. As well as dizziness, nausea and shortness of breath, which would have hinted at some sort of respiratory infection, she had one very worrying sign: she was pale, but had bright cherry red lips. She had been staying with her mother in a rather swish houseboat moored on the Thames at Chelsea.
Because of certain suspicions I sent her to the nearest hospital to have her blood gas composition analysed and it showed carbon monoxide levels in her blood of 22%. Normal levels are around 0.1 to 2%.
She was given oxygen therapy under pressure and thankfully made a full recovery. Investigation revealed a faulty exhaust system on the boat that had causes levels of gasses to build up at the end of the boat where the girl slept.
Carbon monoxide is a colourless and odourless gas that accumulates rapidly in the lungs and blood. It can bind to haemoglobin and does so about 240 times more tightly than oxygen, forming a compound called carboxyhaemoglobin. This means that if both carbon monoxide and oxygen are inhaled, carbon monoxide will preferentially bind to haemoglobin. This reduces the amount of haemoglobin available to bind to oxygen, so the body and tissues become starved of oxygen. Carboxyhaemoglobin also has direct effects on the blood vessels of the body - causing them to become 'leaky'. This is seen especially in the brain, causing the brain to swell, leading to unconsciousness and neurological damage.
Symptoms of toxicity are rather non-specific including headache, nausea, dizziness, confusion, vomiting, and lethargy and are often misdiagnosed. Long-term neurological complications of CO toxicity occur in 14% to 40% of patients and include cerebral oedema, cardiac ischemia, rhabdomyolysis, and thrombosis.
I hate to admit it but I suspect that in private practice CO poisoning is rarely ever considered as a possible diagnosis for a simple reason: we usually think of those at risk of CO poisoning as staying in crummy bed sits and run down hostels: not the type likely to be accessing private healthcare, and certainly not well-heeled Chelsea types. But doctors should never make assumptions about class and background in this way, for obvious reasons: if we misjudge, it could kill.
As if on cue a new national campaign called Carbon Monoxide – Be Alarmed! has just been launched to try to reduce the number of deaths and injuries caused by carbon monoxide poisoning. It’s also lobbying for legislative change to make putting alarms in new builds and rented properties law. According to their research this subject is particularly relevant to us Londoners. We are half as likely as the national average to have an audible carbon monoxide alarm in their home and significantly less likely to understand the risks and characteristics of carbon monoxide.
I had never really thought this much of an issue before. But this recent case of mine was an eye opener. 93% of homes have smoke alarms, but only 15% have carbon monoxide alarms. And as it is the most common cause of fatal poisoning in Britain today, again a fact that I did not know and would never have guessed, this is clearly something we all need to address.
Because of certain suspicions I sent her to the nearest hospital to have her blood gas composition analysed and it showed carbon monoxide levels in her blood of 22%. Normal levels are around 0.1 to 2%.
She was given oxygen therapy under pressure and thankfully made a full recovery. Investigation revealed a faulty exhaust system on the boat that had causes levels of gasses to build up at the end of the boat where the girl slept.
Carbon monoxide is a colourless and odourless gas that accumulates rapidly in the lungs and blood. It can bind to haemoglobin and does so about 240 times more tightly than oxygen, forming a compound called carboxyhaemoglobin. This means that if both carbon monoxide and oxygen are inhaled, carbon monoxide will preferentially bind to haemoglobin. This reduces the amount of haemoglobin available to bind to oxygen, so the body and tissues become starved of oxygen. Carboxyhaemoglobin also has direct effects on the blood vessels of the body - causing them to become 'leaky'. This is seen especially in the brain, causing the brain to swell, leading to unconsciousness and neurological damage.
Symptoms of toxicity are rather non-specific including headache, nausea, dizziness, confusion, vomiting, and lethargy and are often misdiagnosed. Long-term neurological complications of CO toxicity occur in 14% to 40% of patients and include cerebral oedema, cardiac ischemia, rhabdomyolysis, and thrombosis.
I hate to admit it but I suspect that in private practice CO poisoning is rarely ever considered as a possible diagnosis for a simple reason: we usually think of those at risk of CO poisoning as staying in crummy bed sits and run down hostels: not the type likely to be accessing private healthcare, and certainly not well-heeled Chelsea types. But doctors should never make assumptions about class and background in this way, for obvious reasons: if we misjudge, it could kill.
As if on cue a new national campaign called Carbon Monoxide – Be Alarmed! has just been launched to try to reduce the number of deaths and injuries caused by carbon monoxide poisoning. It’s also lobbying for legislative change to make putting alarms in new builds and rented properties law. According to their research this subject is particularly relevant to us Londoners. We are half as likely as the national average to have an audible carbon monoxide alarm in their home and significantly less likely to understand the risks and characteristics of carbon monoxide.
I had never really thought this much of an issue before. But this recent case of mine was an eye opener. 93% of homes have smoke alarms, but only 15% have carbon monoxide alarms. And as it is the most common cause of fatal poisoning in Britain today, again a fact that I did not know and would never have guessed, this is clearly something we all need to address.
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