Common causes of carbon monoxide poisoning include:

Furnaces/HVAC Units
Space Heaters
Hotels/Resorts
Boating
Aviation/Airplanes
Air Crashes
Warehouse Workers
Propane Devices
Generators

PREVENTION: While no prevention technique is foolproof, smoke detectors and carbon monoxide detectors can make a difference in your home. But as with all prevention devices, if such devices are not properly maintained - the batteries kept fresh, or disconnected - they won’t make a difference.

One of the most serious situations for accidental carbon monoxide poisoning is in space heaters in rental apartments or in hotel rooms. Space heaters are not just something found in older apartments. Stand alone heating units also include on the wall heating systems (typically without thermostats) that you find in a high percentage of hotel rooms.

When you stay in a hotel room with an older type system it is a good policy to check to see if there is a carbon monoxide detector in the room. One recommendation is to travel with a portable carbon monoxide detector, as only a few states have a law requiring CO detectors in hotels, and none in all rooms. Hotels

WARNING: Older ski resorts have some of the worst safety records, so be particularly cautious there.

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DELAYED ONSET OF SEVERE SYMPTOMS:

One of the most disturbing and unexpected aspects of carbon monoxide poisoning is the delayed onset of Neurological symptoms. Even more so than with other types of damage to the brain, this type of damage is an elongated process. Behavioral and neurologic deficits can arise or worsen two to 40 days after the exposure. Often times a patient is discharged from the hospital after initial evaluation, to have a severe relapse of symptoms, from this escalating pathology. The toxic effects of CO poisoning continue to attack the neurological system and particularly the brain, for many weeks after the initial exposure. This syndrome, sometimes called DNS (for Delayed Neurological Sequalae) can materialize as almost any neurological or behavioral symptom, including memory loss, confusion, seizures, urinary incontinence, loss of bowel function, disorientation, hallucinations, psychosis and balance and dizziness.

It is believed that DNS is related to “brain lipid peroxidation” which may be a result of carbon monoxide triggering a Nitric Oxide formation in the blood stream.  It may be that a period of unconsciousness is required for DNS to occur thru this mechanism, because it appears to be related to drops in cerebral blood flow (blood flow to the brain), which may also set off an intracell toxic event thru the formation of free radicals.  While a completely different mechanism, similar free radical formations are believed to be a chief component in delayed symptoms following Diffuse Axonal Injury. One experimental treatment modality for DNS is to administer nitric oxide syntheses inhibitors (something that would prevent the formation of nitric oxide) has shown some success.

With these treatment possibilities, it has become considerably more important that the potential for DNS in all carbon monoxide exposure cases be explained. Particularly in those cases involving loss of consciousness, the potential for DNS should be monitored carefully.  The longer a patient is unconscious, the more likely DNS may occur and there is also a dramatic increased risk of DNS with patients over 30.  However, as we have found in other areas of brain damage, it is likely that the prevalence of DNS is significantly understated, as the studies that have looked at neuropsychometric (neuropsychological testing) measures, versus strictly clinical manifestations, the percentage of those with DNS climbs to nearly 50%.

THE DIAGNOSIS OF PERMANENT BRAIN DAMAGE IS SUBTLE, AND IT CANNOT BE RULED OUT BY NORMAL NEUROLOGICAL EXAMS OR IMAGING STUDIES.

NEXT: CARBON MONOXIDE - UNEXPLAINED HEART ATTACKS

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What should I do if I suspect CO in my home?

• Leave your home immediately.
• Call 911 or Poison Control from your cellphone or from a neighbor's house after you have left your house. Seek medical attention.
  
• Call the local fire department to test for CO, or
  call your fuel supplier or licensed
  heating contractor for an
  emergency inspection.

Carbon Monoxide is referred to as CO, because that is the chemical symbol of the molecule, being one atom short of the less deadly, and natural element of the combustion cycle, carbon dioxide, CO2. CO occurs as the result of incomplete combustion, where instead of the normal combustion process, where the fuel containing the carbon atom, combines with two oxygen atoms, only one oxygen atom attaches to the carbon atom, hence CO. The existence of this toxic molecule in the bloodstream, causes potentially catastrophic consequences to the human body, including rapid death.

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