Severe hypoxia produced by concomitant intoxication with sublethal doses of carbon monoxide and cyanide*1

Effect of combined exposure to carbon monoxide and cyanides in selected forensic cases

“…Some authors have moreover demonstrated, with studies carried out on both laboratory animals and subjects who died as a result of inhalation of toxic smokes from the outbreak of a fire, that CO, especially in concentrations that can be defined as sub-lethal, induces a modification of the acid-base balance which determines the establishment of a situation of acidosis which is itself the responsible for a decrease in the affinity of hemoglobin for oxygen (Bohr effect). 8 On this subject it should be remembered that combustion is a chemical reaction that occurs in the presence of oxygen, which is consumed in the same reaction, therefore the environment is gradually deprived of such a gas and this contributes to augmenting the asphyxial effect of the toxic gases, which are formed.…”

Carbon Monoxide Poisoning in Fire Victims

“…Blood concentrations of either CO or cyanide within the potentially toxic but not the potentially lethal range were found in 29 fire victims, of whom 16 (55%) died, suggest ing an additive toxic effect of these gases in humans [29], In accordance with this concept, studies in mice have indicated that death can result from the concomitant exposure to otherwise sublethal doses of CO and cyanide: an augmented inhibition by the two toxicants of cyto chrome oxidase in the central nervous system was pro posed as a possible mechanism of this synergistic lethality [32], Recently, Moore et al [33] showed that mice chal lenged with both CO and cyanide underwent much great er hypoxia than could be explained by a simple additive effect. The synergistic lethal action was related to tissue hypoxia and a rapid decrease in blood pH due to severe lactic acidosis and an inadequate respiratory compensa tion.…”

Behandlungsstrategien des akuten Rauchgasinhalationstraumas

“…Die Situation bei dem Parallelangriff auf das amerikanische Verteidigungsministerium Pentagon war identisch [21,54]. [29]. Betroffene Personen können von den irritierenden Effekten des Rauches und durch eine verminderte O 2 -Konzentration bei ihren Fluchtversuchen beeinträchtigt werden; dies führt zu Verbrennungen und unter zunehmender Hypoxie zur Verwirrung [28,29].…”