Acute carbon monoxide poisoning with low saturation of carboxyhaemoglobin: a forensic retrospective study in Shanghai, China

Abstract

Carbon monoxide (CO) poisoning is a common cause of death, leading to morbidity and mortality worldwide. Features of the CO poisoning with low carboxyhemoglobin (COHb) levels remain to be characterized. This study collected a total of 307 CO poisoning cases from Shanghai Public Security Bureau, an official organization that handles the most complicated and life-threatening cases across Shanghai municipality in China, and regrouped these cases into three categories: group 1, 10% < COHb% < 30% (n = 58); group 2, 30% ≤ COHb% < 50% (n = 79); group 3, COHb% ≥ 50% (n = 170). Epidemiological, demographic, and forensic aspects of the CO poisoning cases, particularly those with low COHb levels, were analyzed. Our results showed that group 2 and 3 were mostly observed in younger victims (≤ 30 years), while group 1 equally distributed to all age groups (p = 0.03). All the CO poisoning from group 2 and 3 occurred in enclosed spaces, whereas cases from group 1 died additionally in outdoor spaces (p = 0.01). 81.03% of group 1 cases died in fire circumstances, while only 45.57% from group 2 and 30.59% from group 3 were fire-related (p = 0.00). Accordingly, group 1 was mostly related with fire burns, while group 2 or 3 were largely associated with gas leakage (p = 0.00). A combination with alcohol, but not other psychotropic drugs, associated with significant higher levels of blood COHb% in fire-unrelated (p = 0.021) but not fire-related cases (p = 0.23). Five extremely low COHb% (< 30%)-related poisoning deaths were negative of any cardiopulmonary pathology and psychoactive substances. In conclusion, CO poisoning with low COHb% significantly associates with fire circumstances and outdoor spaces and has no age preference. Further diagnostic markers mandates to be identified in order to avoid disputes in cases of extremely low COHb%-related poisoning.

Exploring Health Impacts of Occupational Exposure to Carbon Monoxide in the Labour Community of Hattar Industrial Estate

“…The acute CO poisoning was associated with the temperature in Taiwan, where an RR-0.0973 value is less than one, indicating less environmental impact [32]. In the current study, the calculated value of RR was 1.44 for CO poisoning as mentioned in Table 2, which could have severe effects on the health of respondents of steel industries at Hattar.…”

Severe burn injury caused by carbon monoxide poisoning: two case reports

“…The most common symptoms of CO poisoning include nausea, headache, dyspnea and tachycardia. If it is not detected and treated in time, the symptoms will worsen and neurological symptoms, such as hallucinations, dizziness, confusion, seizures, and at a maximum extent to respiratory arrest [10]. When the patient is in a coma, the body may be in direct contact with burning coal or a high-temperature furnace.…”

Analysis of long-term prognosis of neurological sequelae in children with carbon monoxide poisoning

“…This also suggests that COHb level alone cannot be used to judge the severity of poisoning. A forensic study on low COHb levels of carbon monoxide poisoning in Shanghai, China 12 showed that acute carbon monoxide poisoning with low COHb (less than 30%) still resulted in patient death, accounting for 18.9% (58/307) of the total cases studied. A retrospective study conducted by the Portuguese National Institute of Legal Medicine and Forensic Science showed that there was one case of blood and internal organs with cherry red color, but the detected COHb level was only 3% 13 .…”