Carbon monoxide: modern concepts to the treatment of acute poisonings (literature review)

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Abstract

Introduction. Carbon monoxide (CO) is one of the most common causes of chemical injuries and the main toxic factor in the people death in fires. The mechanism of the toxic effect of CO, associated with the formation of carboxyhemoglobin and the development of hypoxia, determines the rapid development of the clinical picture of acute intoxication and the need for emergency first aid and medical care to the poisoned. 

Material and methods. Literature sources, summarized in the bibliographic databases eLIBRARY.RU, PubMed and Scopus, were the material for analysis.

Results. First aid is based on quickly removing the victim from the fire zone or other area with a high concentration of CO and providing him with oxygen as soon as possible. During medical evacuation, it is necessary to carry out continuous inhalation of 80–100% oxygen, to ensure rest and warmth of the victim. In the emergency department of the hospital, oxygen inhalation and maintenance therapy should be continued, clinical and laboratory diagnostic measures aimed at assessing the severity of intoxication, identifying complications and concomitant pathology should be performed. In the case of severe CO poisoning, medical care continues to be provided to the victims in the intensive care unit or in the oxygen-barotherapy unit. The main antidote for CO poisoning is oxygen, which can be used in two versions – normobaric or hyperbaric oxygenation. As a pharmacological antidote to CO, zinc bisvinylimidazole diacetate (acizol) which can accelerate the breakdown of carboxyhemoglobin, improve the oxygen-binding and gas-transport properties of blood, as well as the dissociation of oxyhemoglobin in tissues is used. Along with antidotes, an important role in the treatment of CO poisoning is played by pathogenetic and symptomatic therapy aimed at the prevention and treatment of toxic encephalopathy, brain edema, cognitive dysfunction, toxic myocardiodystrophy and arrhythmia, prevention of pneumonia, correction of the acid-base state, compensation of the energy needs of the body, etc.

Conclusion. Further improvement of existing means and methods for the treatment of intoxication, the development and introduction of new antidots into medical practice will increase the effectiveness of therapeutic measures, reduce the number of deaths and disabilities after acute poisoning with carbon monoxide.

About the authors

Aleksandr Nikolaevich Grebenyuk

Pavlov First Saint Petersburg State Medical University (Pavlov University); Saint Petersburg State Chemical and Pharmaceutical University

Author for correspondence.
Email: grebenyuk_an@mail.ru
ORCID iD: 0000-0002-9381-194X

M.D., Professor, Professor of Mobilization Preparation of Health Care and Disaster Medicine Department of Pavlov First Saint Petersburg State Medical University (Pavlov University), Saint Petersburg, 197022, Russian Federation.

e-mail: grebenyuk_an@mail.ru

Russian Federation

Vladimir Nikolaevich Bykov

The Moscow Institute of Physics and Technology (National Research University)

Email: bykov_imm@mail.ru
ORCID iD: 0000-0001-5755-4045

Доктор медицинских наук, профессор, руководитель проекта ФГАОУ ВО «Московский физико-технический институт (национальный исследовательский университет)», г. Москва.

e-mail: bykov_imm@mail.ru 

Russian Federation

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