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Carbon monoxide - The gas they got too close to - (2/23/2021)

By Dr. Ron Gasbarro 

The pharmacist had a few minutes for lunch and was leafing through the newspaper. "Family of four die trying to stay warm in car," said the headline. Carbon monoxide was the likely cause, the pharmacist read. That family probably never knew what was happening, he thought.  

Death by carbon monoxide (CO) is the stuff of tragedy and legend. Writer Sylvia Plath ("The Bell Jar") famously stuck her head in her gas oven to end it all. Playwright, Oscar and Pulitzer Prize winner William Inge ("Come Back, Little Sheba,” “Picnic”) asphyxiated himself in his Mercedes-Benz. The 1944 Balvano disaster took the lives of over 500 people riding in a coal-burning freight train that broke down in an Italian tunnel. Notably, as part of the Holocaust during World War II, Nazis used CO gas vans at the Chelmno death camp in Poland to exterminate some 700,000 prisoners. 

CO is the Sneaky Pete of the gas world because it is odorless. Most other gases – ammonia, chlorine, and sulfur (Rotten eggs!) have distinctive smells. But not CO. You can pull over into a rest area, turn up the heat, and take a nap, only to never wake up. Compare this to a road trip with your gassy BFF after he wolfed down four chili dogs. Crank open those windows!  

CO does have its merits. The gas is used in vast amounts as an inexpensive chemical reducing agent in steel production and metal refining processes. Yet, any activity in which the combustion of carbon fuel occurs is likely to produce CO. For example, risky levels of this molecule are generated by car and diesel engines, coal, gas, and oil boilers, charcoal grills, and tobacco smoking.  

How does CO kill? The chemistry is as easy as 1-2-3. 1) Carbon dioxide (CO2) has two oxygen molecules, whereby CO has just one. 2) Hemoglobin (Hgb) is the protein in red blood cells that carries oxygen (O) from the lungs to the body's tissues and returns CO2 from the tissues back to the lungs. 3) CO tricks Hgb into believing it is O and bonds with it. While O and red blood cells form a weak bond that quickly breaks down, CO and red blood cells form a strong bond to cut off the body's oxygen supply, crippling or killing the person. If anyone contemplating suicide thinks running the garden hose from the exhaust to the car's interior is the easy way out, beware. With the advent of catalytic converters, CO emissions are far lower than those from older vehicles. So, the possibility exists that you may successfully snuff yourself out in your new BMW. However, the likely scenario will be permanent brain damage with your survivors carrying you to and from the toilet forevermore. Instead, call the National Suicide Prevention Lifeline at 1-800-273-8255. 

Winter is still among us, and people complain they are "freezing to death." This year, the crushing cold and power outages in Texas have taken the souls of those who were just trying to keep warm – so they would not freeze to death. Instead, three children, ages 11, 8, and 5, and their grandmother died after using a faulty fireplace to heat their home. A woman and an 8-year-old girl died, and a man and a 7-year-old boy were hospitalized after being poisoned in their car. And there’s more. According to the CDC, about 430 Americans die from accidental CO poisoning every year. Roughly 50,000 people in the US visit emergency rooms annually due to CO poisoning. The number of suicides from intentional CO poisoning is believed to be at least 2,000. 

Be smart. No hibachis in the living room. No napping in the truck with the engine running. Go to the CDC website – www.cdc.gov - for details on identifying the subtle symptoms of CO poisoning.  

Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press. 

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