Avert Carbon Monoxide Poisoning

Hundreds of people die of unintentional carbon monoxide poisoning and a few thousand are hospitalised every winter in Nepal. Everyone is at risk for carbon monoxide poisoning. However, infants, the elderly, and people with chronic heart disease, anemia, or breathing problems are more likely to be affected by carbon monoxide. Most carbon monoxide poisoning cases are preventable. The exact number of people affected by carbon monoxide poisoning not-related to fires is still unknown in the country.

This problem occurs when carbon monoxide builds up in our bloodstream and mixes with hemoglobin which is a part of red blood cells carrying oxygen around our body to form carboxyhemoglobin. This results in the blood being unable to carry oxygen, and this lack of oxygen causes the body's cells and tissue to suffocate and die. This is to say that when too much carbon monoxide is in the air, our body replaces the oxygen in our red blood cells with carbon monoxide which ultimately causes serious tissue damage or even death.

Danger

The danger it causes to human health is particularly severe in people who are sleeping and/or already intoxicated. A colourless, odorless, tasteless gas, carbon monoxide is produced by burning gasoline, wood, propane, charcoal, or other fuel. A tightly sealed or enclosed space with improper ventilation may allow carbon monoxide to accumulate to dangerous levels and pose danger to human health. The symptoms of carbon monoxide poisoning are deceptive, particularly during low-level exposure. Mild carbon monoxide poisoning causes signs and symptoms such as dull headache, weakness, dizziness, nausea or vomiting, shortness of breath, confusion, blurred vision, and loss of consciousness. 

People exposed to a high level of carbon monoxide may have irreversible brain damage or even die before anyone realises there is a problem. The symptoms of exposure to low levels of carbon monoxide are often similar to those of food poisoning and flu. However, flu results in high temperatures while carbon monoxide poisoning does not.

High levels of carbon monoxide gas exposure can cause more severe symptoms. These may include impaired mental state and personality changes, the feeling that the environment around us is spinning loss of physical coordination and nervous system, breathlessness, a heart rate of more than 100 beats per minute, chest pain caused by angina or a heart attack, muscle spasms, loss of consciousness in cases of exposure to very high levels of carbon monoxide, and death may result within minutes.

The severity of symptoms depends on the length of the exposure. This may result in loss of balance, vision, and memory and, eventually, loss of consciousness depending on the concentration of carbon monoxide in the air. Long-term exposure to low levels of carbon monoxide is also dangerous that can also lead to neurological symptoms such as difficulty thinking or concentrating, repeated emotional changes such as frequent irritation, depression, and impulsive or irrational decision making.

The symptoms can gradually get worse with prolonged exposure to carbon monoxide which may delay and/or produce confusion in diagnosis. These symptoms may be less severe when we are away from the source of carbon monoxide. If this is the case, the possibility of a carbon monoxide leak should be promptly investigated, and consult a suitably qualified professional to check any appliances that may be faulty and leaking gas.

The most common causes of accidental exposure to carbon monoxide are mainly incorrectly installed, poorly maintained or poorly ventilated household appliances. Gas boilers, gas cookers, clay ovens, gas or paraffin heaters, wood, gas, and coal fires, and portable generators are appliances that can cause carbon monoxide. Barbeques or camping stoves inside a closed space, and turning on vehicles in the garage, can also cause a build-up of carbon monoxide at a dangerously high level.

Other possible sources of carbon monoxide poisoning include blocked chimneys which can stop carbon monoxide exhaust leading to reaching dangerous levels of CO, and burning fuel in an enclosed or poorly ventilated space. Therefore, keeping a car engine on, a petrol-powered generator or barbecue inside a garage, a faulty boiler in an enclosed kitchen, or a water heater in bathrooms without ventilation should be avoided. It is important to move the victim away and to open space as soon as possible and take victim to nearby emergency department if carbon monoxide poisoning is suspected. 

Awareness

There are proven preventive measures to avoid carbon monoxide poisoning during the winter season. First, it is suggested to install a carbon monoxide alarm in the home to alert when there is carbon monoxide leakage. However, an alarm cannot be an alternative to regular maintenance and servicing of household appliances that are in use.

Awareness is the key to knowing the dangers and thus, people to be aware of identifying any appliances in the house that could potentially cause carbon monoxide leakage. It is important to regularly maintain and service appliances such as boilers, cookers, and heating systems, and appliances should be installed properly and regularly serviced by a reputable, registered engineer.  It is suggested not to try to install or service appliances yourself that have the potential to produce carbon monoxide.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)