Cheryl Martin (Host): Carbon monoxide is gas that has no odor, taste, or color. Experiencing carbon monoxide poisoning can lead to serious tissue damage or even death. Here to tell us more, including the causes of carbon monoxide poisoning and how to prevent it, is Dr. Ari Filip, Medical Director at the Arkansas Poison and Drug Information Center at UAMS.

 This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences, and I'm Cheryl Martin. Dr. Filip, delighted you're here to discuss this vital topic.

Dr. Ari Filip: Thanks so much for having me. This is really important this time of year.

Host: What causes carbon monoxide poisoning?

Dr. Ari Filip: Carbon monoxide is caused by burning fuel. So, common things that might cause this are things like generators, really big culprit; furnaces, fireplaces, wood-burning stoves. So, expectedly, a lot of these cases happen in the fall and winter. It's really seasonal. I worry about it a lot around the holidays and around this time of year.

Host: Talk about the symptoms of carbon monoxide poisoning.

Dr. Ari Filip: Unfortunately, they can be kind of non-specific, they might start with something mild like headache or dizziness. And then, nausea and vomiting are common, especially in the winter, it might even mimic a viral illness like the flu. But in severe cases, ultimately, it can lead to unconsciousness, lack of oxygen delivery to vital organs, low blood pressure, or even death.

Host: If you can go into more detail, what actually causes the carbon monoxide poisoning?

Dr. Ari Filip: It has to do with the burning of the carbon in the fuel. Actually, anything that burns fuel or burns carbon produces this as kind of a side reaction. Some things that burn a lot more efficiently than others. Cars have catalytic converters to try to prevent carbon monoxide overproduction. But there are some things that are more notorious for generating this. And big culprits would be things like our generators, are really what we worry about. They will disproportionately create carbon monoxide as they're producing energy. Other things are a little bit less worrisome. But one of the other big culprits is not even necessarily the appliance that's producing this, but the context. And so, it's when people are using this in unventilated spaces like garages or even within their homes is really what worries us.

Host: I also understand, even using your gas oven or the stove, that could be a factor as well, if it's in tight quarters without ventilation?

Dr. Ari Filip: This is something that's a potential source, usually not as common. And it's really important that, occasionally, certain culprits be inspect it and we make sure that they're working appropriately. And mostly, just because we often don't expect some of these things to end up malfunctioning, it's important to have carbon monoxide sensors and have measures in place to try to prevent against.

Host: In addition to the detector, which you highly recommend, are there other steps to prevent carbon monoxide poisoning?

Dr. Ari Filip: Making sure that if you have something like a fireplace, that it's working appropriately, that it's inspected, the ventilation is inspected, that things don't get blocked off. For example, in the winter, things like snow drifts, less common here in Arkansas, but these can occlude ventilation.

And then, making sure that any time you're using something that could potentially generate carbon monoxide, people using generators, should really be using these outside the house at least 20 feet away from your house. Regularly inspecting common culprits and then, using generators outside the house. If you're going to be starting your car, make sure that the garage door is open or else carbon monoxide can accumulate as well.

Host: You mentioned the carbon monoxide detectors. How many do you need?

Dr. Ari Filip: Ideally, you should have at least one per floor of your house. And importantly not just having them, but making sure that they're working. So, a good rule of thumb would be to swap the batteries out about every six months and so. What someone I know does is every time it's daylight savings time, just go ahead in addition to changing your clocks, go ahead and swap out the batteries in your carbon monoxide sensor. So, make sure not just that you have it and you have it on each floor of your house, but that it is working appropriately.

Host: Now, do you find that they are as popular as people having fire alarms in their homes?

Dr. Ari Filip: So, it depends. In some places, they actually mandate having these sensors. And so, it varies in place to place. Now, one of the important things is that not all smoke detectors also have carbon monoxide detectors. What I worry is that sometimes people might think that they have a carbon monoxide detector, but really what they have is smoke alarm or smoke detector. Now, sometimes they're sold as like a dual sensor, but that's not always the case.

Host: What should you do if you've been exposed? Because I'm assuming you may not be aware that you have been.

Dr. Ari Filip: The most important thing is to just go ahead and get outside, get somewhere safe and get to fresh air. Treatment for carbon monoxide poisoning is to get to oxygen and get away from the source of exposure. So, that's the very first thing, just go ahead and step outside.

Host: You talked about the symptoms, but a lot of those symptoms could be for other things as well, right?

Dr. Ari Filip: Yeah, absolutely. And so, if this is at all on your radar, I would just take the safest first step, which would be to get away from the source of potential exposure. And then, I would make sure that, if you have a carbon monoxide sensor, you would have hopefully heard it go off at that point. But if you don't happen to have one, would either give the fire department a call because they can usually come out and, check and see if there are high levels of carbon monoxide, or just go ahead and give us a call at the Poison Center and we can kind of direct you towards the next steps. We always welcome calls for people who are concerned that they could have been exposed to carbon monoxide, and we're more than happy to guide them on what to do next.

Host: I'm glad you mentioned the Poison Center. Tell us more about it and how people can contact it and what other things you can help them with at the Poison Center.

Dr. Ari Filip: The Poison Center, there's one national number that anyone can dial. It's 1-800-222-1222, so it's a palindrome, it's very convenient, so 800-222-1222, and it will direct you to your state or regional poison center. And it's open 24/7, 365, the phones are always staffed by specially trained pharmacists, nurses, and they are always happy to direct you on what are the next steps.

And so, not just carbon monoxide, but anytime you're concerned for potential poisoning, accidental doses of medications, taking somebody else's medication by accident, concern for medication interactions. We answer calls about things like snake bites and, other potential exposures.

So, the important thing is that if we can't answer your question, which hopefully most of the time we can, we can direct you towards next steps. And we also are a resource for healthcare facilities, which is around where about 20% of our calls come from. We advise them on some of these less commonly seen exposures and help to direct them on how to treat things, including carbon monoxide poisoning.

Host: Talking about carbon monoxide poisoning, are some at greater risk?

Dr. Ari Filip: Yeah. So, we especially worry about very young children and elderly patients. They may not have the same, we use the term physiologic reserve when they're poisoned, which is to say that their bodies may not be able to compensate as well when they're exposed to this. Especially young children, they breathe faster, they're ventilating more quickly. This can potentially make it into their system a little bit more quickly.

Host: We talked about how Carbon monoxide poisoning can lead to death. When you look at that situation, is it a combination of, let's say, age as well as the intensity of the poisoning or how long the person has been exposed? What's the perfect storm that leads to that?

Dr. Ari Filip: Certainly, the intensity matters. So, you're in a closed room with a generator, this is something that would be extremely worrisome. I wouldn't say that it necessarily just relates to age, because we have young healthy people that all the time get exposed to this. It's a common occupational cause when people are, say, working in their garage on something. The most worrisome thing is that this can happen relatively quickly and sometimes I think people's first inclination is maybe just to kind of lie down and rest or relax or maybe give themselves a second to think about what they want to do next if they're feeling sick. And then, unfortunately, what happens is that people will lose consciousness, and then they will succumb to the poisoning because they won't be able to make it outside to fresh air.

So, the most important thing is that if you think that you may be poisoned by carbon monoxide, just go ahead and get outside and then give us a call. It scares me that it's just not something that we think about too often.

Host: This discussion, I believe, has caused people to think more about it, certainly for me, so I just want to thank you, Dr. Ari Filip, for educating us on carbon monoxide poisoning and how we can protect ourselves. Thank you so much.

Dr. Ari Filip: Yeah, I appreciate you having me on here.

Host: Please put this number, 800-222-1222, the poison hotline number into your cell phone speed dial so you can speak with a certified specialist in poison information for whatever poisoning or medication problem you may have. Again, that number is 800-222-1222.

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