PROJECT REPORT

CARBON MONOXIDE











SUBMITTED TO: SUBMITTED BY:
DR. AJAY RANGA VARUN BHARDWAJ
ROLL NO.-204/10
SEMESTER-IX
INDEX

1) ACKNOWLEDGEMENT. 2
2) INTRODUCTION.. 3
3) SOURCES OF CARBON MONOXIDE. 4
4) DANGERS OF CARBON MONOXIDE 5
5) CARBON MONOXIDE POISIONING.. 6
6) DIAGNOSIS 8
7) DETECTION 11
8) CONCLUSION 13
9) BIBLIOGRAPHY. 14















Carbon Monoxide
~Forensic Science~
2
ACKNOWLEDGMENT
I would like to thank our Honorable teacher Dr. Ajay Ranga, for without his valuable
guidance, constant encouragement and detailed approach would not have made it possible for
me to make a proper research for the topic- Objective and Scope of Forensic Science. His
prcised examples, detailed descriptions and enthusiastic approach made my efforts to
flourish in a right direction.
The work contained herein is an amalgamation of the remarkable work of various authors and
I am thankful to them for their publications that have helped me prepare this research paper to
the best of my abilities.

Carbon Monoxide
~Forensic Science~
3
INTRODUCTION
Carbon monoxide (CO) is a colorless, odorless, and tasteless gas that is slightly less dense
than air. It is toxic to humans and animals when encountered in higher concentrations,
although it is also produced in normal animal metabolism in low quantities, and is thought to
have some normal biological functions. In the atmosphere, it is spatially variable and short
lived, having a role in the formation of ground-level ozone.
Carbon monoxide is produced from the partial oxidation of carbon-containing compounds; it
forms when there is not enough oxygen to produce carbon dioxide(CO
2
), such as when
operating a stove or an internal combustion engine in an enclosed space. In the presence of
oxygen, including atmospheric concentrations, carbon monoxide burns with a blue flame,
producing carbon dioxide.
1
Coal gas, which was widely used before the 1960s for domestic
lighting, cooking, and heating, had carbon monoxide as a significant fuel constituent. Some
processes in modern technology, such as iron smelting, still produce carbon monoxide as a
byproduct.
2




1
Thompson, Mike. Carbon Monoxide Molecule of the Month, Winchester College, UK.
2
Ayres, Robert U. and Ayres, Edward H. (2009). Crossing the Energy Divide: Moving from Fossil Fuel Dependence to a Clean-
Energy Future. Wharton School Publishing.
Carbon Monoxide
~Forensic Science~
4
SOURCES OF CARBON MONOXIDE
Incomplete combustion occurs in all fires and even in the most efficient appliances and
furnaces. All fossil fuels (e.g. coal, fuel oil, kerosene, gasoline, natural gas) contain carbon,
as do other natural fuels (wood and charcoal). When these fuels burn (or oxidize), CO may be
emitted as one of the gaseous by-products. We are usually surrounded by potential sources,
since so many home gas and oil appliances (furnaces, refrigerators, clothes dryers, ranges,
water heaters, space heaters), fireplaces, charcoal grills, and wood burning stoves use fossil
fuels as their source of energy. Fumes from automobiles and gas-powered lawn tools also
contain carbon monoxide. Tobacco smoke produces low levels of CO in the smoker;
however, the long term effects are not clear and are overshadowed by other detrimental
effects associated with smoking.
Additionally, the inhalation of methylene chloride (CH2CI), a popular industrial solvent
found in home products such as paint and varnish strippers, may result in CO poisoning via
its conversion in the liver to carbon monoxide. Contrary to popular belief, the inhalation of
unburned gaseous fuel (e.g. natural gas and propane) cannot produce CO poisoning; the fuel
must first be burned.
Properly adjusted gas burners in residential heating appliances produce little CO, typically
less than 50 parts per million (ppm). incorrectly operating burners can produce CO in
extremely high concentrations, with units in excess of 4,500 ppm found. Reasons for excess
CO production from heating appliance burners may include: insufficient air to burner, rust
and dirt on burners, air blowing across burners, excess gas pressure, and incorrectly adjusted
air shutters. Some sources always produce high concentrations of CO, such as wood burning
in an open fireplace. smoldering embers, charcoal, and most small gasoline engines. Release
of combustion products from any of these sources into enclosed areas is always extremely
dangerous and must be avoided. All gasoline engines, even those with catalytic converters,
produce high concentrations of carbon monoxide when first started. During a cold start,
tailpipe concentrations can exceed 90,000 ppm Catalytic converters, after warm up, reduce
CO concentrations to only a few parts per million.

Carbon Monoxide
~Forensic Science~
5
DANGERS OF CARBON MONOXIDE
Carbon monoxide is rapidly absorbed by the lungs and quickly passes to the blood. The
affinity of CO and the red blood cells, hemoglobin, is 2;0 to 270 times greater than the
affinity of oxygen and hemoglobin. Hemoglobin carrying CO (carboxyhemoglobin), is
incapable of releasing oxygen to the tissues. Even small amounts of carbon monoxide in the
air breathed will quickly increase the percentage of carboxyhemoglobin. For instance,
breathing air with 0.0 I % ( 100 ppm)carbon monoxide for two hours has been shown to
increase blood carboxyhemoglobin concentrations to 16.0%, a concentration that can cause
CO poisoning symptoms.
After breathing carbon monoxide three to four hours of breathing fresh air eliminates only
half the CO from the blood (i.e. a three to four hour half-life). Carbon monoxide is an
extremely dangerous poison because it can not be seen. smelled. or tasted. Early symptoms
are similar to the flu. Because CO reduces oxygen delivery to the brain, persons with elevated
levels of CO in their blood do not think; clearly, and might not recognize the warning signs.


Carbon Monoxide
~Forensic Science~
6
CARBON MONOXIDE POISIONING
Carbon monoxide poisoning occurs after enough inhalation of carbon monoxide (CO).
Carbon monoxide is a toxic gas, but, being colorless, odorless, tasteless, and initially non-
irritating, it is very difficult for people to detect. Carbon monoxide is a product of incomplete
combustion of organic matter due to insufficient oxygen supply to enable complete oxidation
to carbon dioxide (CO
2
). It is often produced in domestic or industrial settings by motor
vehicles that run on gasoline, diesel, propane, methane, or other carbon-based fuels and tools,
heaters, and cooking equipment that are powered by carbon-based fuels. Exposures at
100 ppm or greater can be dangerous to human health.
3

Symptoms of mild acute poisoning will include light-headedness,
confusion, headaches, vertigo, and flu-like effects; larger exposures can lead to significant
toxicity of the central nervous system and heart, and even death. Following acute poisoning,
long-term sequelae often occur. Carbon monoxide can also have severe effects on the fetus of
a pregnant woman. Chronic exposure to low levels of carbon monoxide can lead
to depression, confusion, and memory loss. Carbon monoxide mainly causes adverse effects
in humans by combining with hemoglobin to form carboxyhemoglobin (HbCO) in the blood.
This prevents hemoglobin from releasing oxygen in tissues, effectively reducing the oxygen-
carrying capacity of the blood, leading to hypoxia. Additionally, myoglobin and
mitochondrial cytochrome oxidase are thought to be adversely affected. Carboxyhemoglobin
can revert to hemoglobin, but the recovery takes time because the HbCO complex is fairly
stable.
Treatment of poisoning largely consists of administering 100% oxygen or
providing hyperbaric oxygen therapy, although the optimum treatment remains
controversial.
4
Oxygen works as an antidote as it increases the removal of carbon monoxide
from hemoglobin, in turn providing the body with normal levels of oxygen. The prevention of
poisoning is a significant public health issue. Domestic carbon monoxide poisoning can be
prevented by early detection with the use of household carbon monoxide detectors. Carbon
monoxide poisoning is the most common type of fatal poisoning in many

3 Prockop LD, Chichkova RI (Nov 2007). "Carbon monoxide intoxication: an updated review".Journal of the Neurological
Sciences
4 Buckley NA, Isbister GK, Stokes B, Juurlink DN (2005). "Hyperbaric oxygen for carbon monoxide poisoning: a systematic
review and critical analysis of the evidence".
Carbon Monoxide
~Forensic Science~
7
countries.
5
Historically, it was also commonly used as a method to commit suicide, usually
by deliberately inhaling the exhaust fumes of a running car engine. Modern automobiles,
even with electronically-controlled combustion and catalytic converters, can still produce
levels of carbon monoxide which will kill if enclosed within a garage or if the tailpipe is
obstructed (for example, by snow) and exhaust gas cannot escape normally. Carbon
monoxide poisoning has also been implicated as the cause of apparent haunted houses;
symptoms such as delirium and hallucinations have led people suffering poisoning to think
they have seen ghosts or to believe their house is haunted.
6


5
Omaye ST (Nov 2002). "Metabolic modulation of carbon monoxide toxicity".
6
Albert Donnay. "A True Tale Of A Truly Haunted House"
Carbon Monoxide
~Forensic Science~
8
DIAGNOSIS
The most common test for carbon monoxide poisoning is the blood test for
carboxyhemoglobin (COHb) measured at the time of hospital admission. However, this test
is susceptible to false negatives. As with all other neurologic conditions, the soft signs will
point to disability well before the laboratory evidence may indicate it.
Think of this analogy: early onset of Alzheimer's appears years before disease has progressed
to the point that neuroimaging can see the lesions. Yet, there is no doubt of a cognitive or
neurobehavioral decline. The difference is that with Alzheimer's, the laboratory results will
eventually catch up with the symptoms because of the progressive nature of the disease and
the age of the patient makes the diagnosis one which the average practitioner is comfortable
making without so called scientific proof.
Being late on the diagnosis of carbon monoxide is far more serious than being late on
diagnosis of Alzheimer's. First, in a chronic exposure situation, you may be sending the
patient back into a toxic environment, where the exposure could continue or worsen. Second,
the Delayed Neurological Sequalae may result in severe disability.
Other laboratory tests to consider as non-exclusive additions to the diagnostic effort include:
pulse oximetry,
complete blood count,
arterial blood gas monitoring,
electrolytes,
cardiac markers,
blood uera nitrogen,
creatinine,
creatine phosphokinese,
chest radiography
and ECG.
Carbon Monoxide
~Forensic Science~
9
As many symptoms of carbon monoxide poisoning also occur with many other types of poisonings
and infections (such as the flu), the diagnosis is often difficult.
7
A history of potential carbon
monoxide exposure, such as being exposed to a residential fire, may suggest poisoning, but the
diagnosis is confirmed by measuring the levels of carbon monoxide in the blood. This can be
determined by measuring the amount of carboxy hemoglobin compared to the amount of
hemoglobin in the blood.
8

As people may continue to experience significant symptoms of CO poisoning long after their blood
carboxyhemoglobin concentration has returned to normal, presenting to examination with a normal
carboxyhemoglobin level (which may happen in late states of poisoning) does not rule out poisoning.
9

A CO-oximeter is used to determine carboxyhemoglobin levels.
10
Pulse CO-oximeters estimate
carboxyhemoglobin with a non-invasive finger clip similar to apulse oximeter. These devices function
by passing various wavelengths of light through the fingertip and measuring the light absorption of
the different types of hemoglobin in the capillaries.
11

The use of a regular pulse oximeter is not effective in the diagnosis of carbon monoxide poisoning as
people suffering from carbon monoxide poisoning may have a normal oxygen saturation level on a
pulse oximeter.

This is due to the carboxyhemoglobin being misrepresented as oxyhemoglobin.
12

Breath CO monitoring offers a viable alternative to pulse CO-oximetry. Carboxyhemoglobin levels
have been shown to have a strong correlation with breath CO concentration. However, many of these
devices require the user to inhale deeply and hold their breath to allow the CO in the blood to escape
into the lung before the measurement can be made. As this is not possible in a nonresponsive patient,
these devices are not appropriate for use in on-scene emergency care detection of CO poisoning.
13


Differential diagnosis
There are many conditions to be considered in the differential diagnosis of carbon monoxide
poisoning. The earliest symptoms, especially from low level exposures, are often non-specific and
readily confused with other illnesses, typically flu-like viral syndromes, depression, chronic fatigue
syndrome, chest pain, andmigraine or other headaches.
[79]
Carbon monoxide has been called a "great

7
Varon J, Marik PE, Fromm RE Jr, Gueler A (1999). "Carbon monoxide poisoning: a review for clinicians". The Journal of
Emergency Medicine
8
Lewis Goldfrank; Neal Flomenbaum; Neal Lewin; Mary Ann Howland; Robert Hoffman; Lewis Nelson (2002). "Carbon
Monoxide". Goldfrank's toxicologic emergencies (7th ed.). New York: McGraw-Hill. pp. 16891704.
9
Kele A, Demircan A, Kurtolu G (June 2008). "Carbon monoxide poisoning: how many patients do we miss?". European
Journal of Emergency Medicine 15 (3): 154157
10
Rees PJ, Chilvers C, Clark TJ (January 1980)
11
Coulange M, Barthelemy A, Hug F, Thierry AL, De Haro L (March 2008)
12
Vegfors M, Lennmarken C (May 1991). "Carboxyhaemoglobinaemia and pulse oximetry". British Journal of Anaesthesia
13
Jarvis, M. (1986). "Low cost carbon monoxide monitors in smoking assessment". Thorax: 886887
Carbon Monoxide
~Forensic Science~
10
mimicker" due to the presentation of poisoning being diverse and nonspecific.

Other conditions
included in the differential diagnosis include acute respiratory distress syndrome, altitude
sickness, lactic acidosis, diabetic ketoacidosis, meningitis,methemoglobinemia, or opioid or toxic
alcohol poisoning.
14


Detection in biological specimens
Carbon monoxide may be quantitated in blood using spectrophotometric methods or chromatographic
techniques in order to confirm a diagnosis of poisoning in a person or to assist in the forensic
investigation of a case of fatal exposure. Carboxyhemoglobin blood saturations may range up to 8
10% in heavy smokers or persons extensively exposed to automotive exhaust gases. In symptomatic
poisoned people they are often in the 1030% range, while persons who succumb may have
postmortem blood levels of 3090%.
15


14
Shochat, Guy N (17 February 2009). "Toxicity, Carbon Monoxide". emedicine
15
R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp.
237241
Carbon Monoxide
~Forensic Science~
11
DETECTION
CO poisoning is known as the great imitator for its ability to present with equivocal signs and
symptoms, many of which closely resemble other diseases. In particular, patients may be
misdiagnosed with viral illness, acute myocardial infarction, and migraine. It is estimated that CO
poisoning misdiagnosis may occur in up to 30-50 percent of CO-exposed patients presenting to
emergency departments.
Regardless of the means of detection used in emergency department care, several factors make
assessing the severity of the CO poisoning difficult. The length of time since CO exposure is one such
factor. The half-life of CO is four to six hours when the patient is breathing room air, and 4060
minutes when the patient is breathing 100 percent oxygen. If a patient is given oxygen during their
transport to the emergency department, it will be difficult to know when the COHb level peaked.
16

In addition, COHb levels may not fully correlate with the clinical condition of CO-poisoned patients
because the COHb level in the blood is not an absolute index of compromised oxygen delivery at the
tissue level. Furthermore, levels may not match up to specific signs and symptoms; patients with
moderate levels will not necessarily appear sicker than patients with lower levels.
17

In hospitals, the most common means of measuring CO exposure is through the use of a laboratory
CO-Oximeter. A blood sample, under a physician order, is drawn from either venous or arterial vessel
and injected into a lab CO- Oximeter. The laboratory device measures the invasive blood sample
using a method called spectrophotometric blood gas analysis.
18
Because the CO-Oximeter can only
yield a single, discrete reading for each aliquot of blood sampled, the reported value is a
noncontinuous snapshot of the patients condition at the particular moment that the sample was
collected. To compound the difficulty of detecting CO exposure, when the laboratory calculates the
patients oxygen saturation levels from the oxygen partial pressure (PO2), the arterial SaO2 may
appear normal. The clinical usefulness of CO-Oximetry is inhibited further by the relative deficiency
of devices currently installed in acute care hospitals. One recent study found that fewer than half of
hospitals in the U.S. have the necessary equipment on site to diagnose CO poisoning.
19
For those that
did not have the testing equipment, the average time to receive results of a blood sample sent to

16 Wright J. Chronic and occult carbon monoxide poisoning: we dont know what were missing. Emerg Med
J.2002;19(5):386-90.
17 Abelsohn A, et al. Identifying and managing adverse environmental health effects: 6. Carbon monoxide poisoning. CMAJ.
2002;166(13):1685-90
18 Cunnington AJ, Hormbrey P: Breath analysis to detect recent exposure to carbon monoxide. Postgraduate Medical
Journal. 78(918):233237, 2002
19 Hampson NB, Scott KL, Zmaeff JL. Carboxyhemoglobin measurement by hospitals: implications for the diagnosis of
carbon monoxide poisoning. J Emerg Med. 2006 Jul;31(1):13-6.

Carbon Monoxide
~Forensic Science~
12
another facility was over 15 hours. In hospitals that have CO-Oximetry equipment, results may be
returned in an average of 10 minutes.
Unfortunately, standard pulse oximeters are incapable of isolating the carbon monoxide contaminated
hemoglobin from the oxyhemoglobin.
20
Thus, pulse oximeters artificially overestimate arterial oxygen
saturation in the presence of elevated blood carbon monoxide. Therefore, the readings will be falsely
high when carbon monoxide is occupying binding sites on the heme molecule.
The latest technology in CO poisoning detection employs a noninvasive and continuous platform. The
Masimo SET with Rainbow Technology Pulse CO-Oximeter Monitor [Masimo, Irvine, CA] is the
first device that allows clinicians to detect and continuously monitor CO levels in the bloodstream
noninvasively. Using 7+ wavelengths of light to distinguish the various forms of hemoglobin (oxy-,
deoxy-,carboxy- and met-) the device is capable of measuring blood CO saturation (SpCO) levels,
methemoglobin saturation (SpMet) levels, in addition to pulse rate, arterial oxygen saturation, and
perfusion index. The devices accuracy has been demonstrated accurate to 40 percent SpCO, with a
range of 3 percent around the measurement.
Noninvasive monitoring reduces the opportunity for hospital acquired infection and overall patient
discomfort. Needle-free testing means a safer environment for patients and caregivers alike. In
addition, the immediacy of results available at the point-of-care results in less drain on resources
while expediting efficacious treatment and better outcomes. The continuous nature of the noninvasive
Rainbow Pulse CO-Oximeter device enables the ability to trend data over time while conventional
CO-Oximetry requires a new blood sample each time the status of the dyshemoglobins is required.

20
Hampson NB: Pulse oximetry in severe carbon monoxide poisoning. Chest.114(4):10361041, 1998

Carbon Monoxide
~Forensic Science~
13
CONCLUSION
The effects of CO poisoning can be reversed if caught in time. Detection and diagnosis of CO
poisoning is currently based upon clinical suspicion and confirmed by invasive blood sampling for
COHb analyzed by CO-Oximetry. While many hospitals have blood gas machines with CO-
Oximetry, many smaller hospitals do not, which makes timely confirmed diagnosis of CO poisoning
in these situations impossible. Organs with a high metabolic requirement for oxygen, such as the heart
and brain, are particularly susceptible to injury from CO. The resulting tissue ischemia can lead to
organ failure, permanent changes in cognition, or death. Those that survive the initial poisoning may
experience serious long-term neurological, cardiac, metabolic, pulmonary and renal impairment as a
result of their CO exposure.
With lives and significant resources at stake, the speed at which suspicion evolves to diagnosis is
critical. A quick noninvasive measurement of COHb using the new Masimo Pulse CO-Oximeter
device may contribute to better informed treatment decisions ending the guessing game.


Carbon Monoxide
~Forensic Science~
14
BIBLIOGRAPHY
Books
Textbook of Modis Medical Jurisprudence and Toxicology, K. Kannan and K.
Mathiharan, Buttersworths India, 2012
Medical Jurisprudence, R.M. Jhala and K Raju, Eastern Book Company, 1997.
Analytical Toxicology, S.N. Tiwari, Govt of India Publication, New Delhi, 1987.
Websites
http://forensiclaw.uslegal.com
http://lawforensics.org
http://www.annexpublishers.com/journals/journal-of-forensic-science-and-
criminology/aims-and-scope.php
E-Books
Porter, Roy; Lorraine Daston; Katharine Park. The Cambridge History of Science:
Volume 3, Early Modern Science
Madea, Burkhard. Handbook of Forensic Medicine. Sussex: Wiley Blackwell
Lindemann, Mary. Medicine and Society in Early Modern Europe. Cambridge:
University of Cambridge