Carbon monoxide poisoning: emerging and overlooked causes

Abstract

Carbon monoxide poisoning is a subtle and insidious medical emergency. Due to its ability to mimic other conditions such as influenza, food poisoning, vestibular disorders, acute coronary syndrome, or epileptic seizures, it has been referred to as the “chameleon of emergencies”. While fires are a well-recognized source of carbon monoxide exposure, cases in which the origin remains unknown to both physicians and patients are increasingly reported. To enhance awareness of emerging and overlooked sources of carbon monoxide poisoning and summarize its pathophysiology, we conducted a narrative review. We systematically searched the National Library of Medicine. The toxicity of carbon monoxide relies on impaired blood oxygen transport and inhibition of the mitochondrial respiratory chain in the tissues. Less recognized sources include domestic combustion appliances (boilers, water heaters, stoves, ovens, and fireplaces), external heating sources (heating mushrooms), motor vehicle exhaust (cars, motorcycles, scooters, lawnmowers), sports-related activities (mud bogging, ice resurfacing machines), misuse of barbecues, portable power generators, and the use of narghile and cigarettes. Given the nonspecific presentation of carbon monoxide poisoning, improving recognition and diagnostic strategies is essential. Greater awareness among healthcare professionals, along with the integration of advanced diagnostic tools such as pulse oximeters capable of measuring carboxyhemoglobin levels, could facilitate earlier diagnosis and improve patient outcomes.