Carbon Monoxide Poisoning: Pathophysiology, Diagnosis, and Forensic Challenges in Fatal Exposures

Abstract

Carbon monoxide (CO) poisoning is a serious worldwide public health concern and the primary cause of unintentional toxic fatalities [5, 8, 15]. Many instances remain undiagnosed, leading to increased morbidity and death. As it is colorless, odorless, and non-irritating, it is also known as the “silent killer.” [5, 11] Its toxicity is largely due to carboxyhemoglobin production, which lowers oxygen supply, combined with mitochondrial dysfunction, oxidative stress, and inflammation, notably damaging the brain and heart [5, 8, 10]. The clinical presentation varies from modest symptoms such as headache and dizziness to severe neurological impairment, cardiac problems, coma, and death. [8, 11, 15] Diagnosis might be challenging since signs and symptoms are non-specific and the usual methods of COHb testing and imaging are limited, especially in fatal cases [1, 15]. This review covers CO toxicokinetics, etiology, clinical characteristics, diagnostics, and treatment options, including hyperbaric oxygen therapy [12, 14, 15]. It also discusses the delayed neurological sequelae and forensic aspects of CO poisoning, including autopsy results and medico-legal review [1, 2, 3] , as well as novel biomarkers and preventative methods for future clinical and forensic practice.