Keith W. Van Meter
Carbon monoxide (CO) exposure and toxicity is a potentially lethal disorder with immediate and delayed side effects. EPIDEMIOLOGY
In the United States and most industrialized countries, CO is the single toxin responsible for more mortality and morbidity than any other. 12 Industrial sources of CO include fossil fuel engine exhaust, gas- or coal-heater emissions, smoke from accidental fires, and fumes from cupolas of steel foundries, pulp paper mills, or formaldehyde-producing plants. Indoor burning of charcoal—particularly in some countries such as Korea, with a tradition of charcoal subfloor home heating—produces a disproportionate level of accidental CO intoxication. 3 Unintentional CO toxicity and deaths are more common in northern climates and during the winter months.4
Interestingly, industrial sources produce slightly less environmental CO per land area as compared with CO produced from the burning of tropical forests. 5 Little is known about the impact these low atmospheric levels have on health. It is known that regular cigarette smoking can produce carboxyhemoglobin (HbCO) levels of 5 to 10 percent, and this chronic CO exposure is implicated in the acceleration of atherosclerosis seen in smokers. Truck drivers sitting in the cabs of their vehicles in heavy traffic can reach similar levels of HbCO as tobacco smokers. Besides combustion, CO toxicity can develop when inhaled methylene chloride vapor in paint strippers or from leaking "bubble" electric Christmas tree lights is slowly metabolized to produce CO. 6
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