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Carbon monoxide poisoning in Beirut, Lebanon: Patient's characteristics and exposure sources Abstract INTRODUCTION Carbon monoxide(CO)poisoning is common, accounting for more than 50,000 emergency department(ED)visits in the US yearly.It is a seasonal disease with higher incidences during fall and winter months and peaks around December and January secondary to increased use of furnaces and heaters.CO poisoning is also a preventable disease that can acutely lead to rapid health deterioration from seizure and death.Chronic neurologic sequelae such as memory deficits, sleep disturbances, vertigo, neuropathies, and paresthesias have also been described as a result of CO poisoning.The diagnosis of acute CO poisoning can be challenging since the presenting symptoms are usually nonspecific.These include but are not limited to headache, dizzine, confusion, myalgias, lo of consciousne, and death.High clinical suspicion is therefore needed to detect CO poisoning.A serum carboxyhemoglobin(CO-Hb)level is usually ordered to confirm the diagnosis: Levels higher than 3% in nonsmokers and higher than 10% in chronic smokers are considered abnormal.CO-Hb levels above 5% usually require treatment with normobaric high flow oxygen(administration of 100% oxygen at atmospheric preure).This treatment speeds up the elimination of CO by shortening the CO-Hb half-life from 4 to 6 h at room air down to approximately 1 h.Hyperbaric oxygen therapy which reduces the CO-Hb elimination half-life further down to 20 min has also been recommended for serious CO poisoning including patients who have a CO-Hb level of 25% or more and patients with cardiac and severe neurologic symptoms.The source of CO must be identified and removed to prevent CO poisoning.In developed countries, CO sources include house fires, faulty furnaces, inadequate ventilation of heating sources, and exposure to engine exhaust.Data from developing countries regarding this preventable disease is scarce.Our study described demographic and clinical characteristics, causes, treatment modalities, and outcomes of confirmed cases of CO poisoning treated at a tertiary care center in Beirut, Lebanon.The study also determined the aociation between CO poisoning source and the different patients’ characteristics.CONCLUSION CO poisoning in Beirut, Lebanon is mainly due to charcoal burning grills used indoors and to fire-related smoke.Young females present more often to the ED with CO exposure from charcoal burning grills indoors.An opportunity for prevention is present in terms of education and increased awarene regarding CO emiion sources.Patients were symptomatic with CO-Hb levels as low as 2.7%.Clinicians must have high suspicion to diagnose CO poisoning and must recognize the pitfall of excluding CO poisoning as a diagnosis solely based on CO-Hb level.
