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<< Carbon Monoxide Poisoning In Children: Diagnosis And Management In The Emergency Department

Pathophysiology

CO is of similar density to ambient air, so it diffuses and lingers in an unventilated room and neither rises to the ceiling nor falls to the floor. CO molecules are small enough to penetrate through most drywall in the United States.33 It rapidly diffuses into the pulmonary circulation and reversibly binds the heme moiety of hemoglobin at 200 to 250 times the affinity of oxygen, creating carboxyhemoglobin (COHb).34,35

At normal physiologic levels, endogenous CO functions as a neurotransmitter and may favorably modulate inflammation and the cell cycle.36 However, at levels > 2% COHb, CO impairs the ability of heme to deliver oxygen both by directly occupying oxygen-binding sites and by causing a conformational change to the other 3 oxygen-binding sites. 

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