Case Study – Carbon Monoxide Poisoning and Its Impact on Oxygen Transport and Hemoglobin Function

Case Study – Carbon Monoxide Poisoning and Its Impact on Oxygen Transport and Hemoglobin Function

Mr Lucas, a 45-year-old male, was exposed to carbon monoxide (CO) when using a gas-powered generator in a closed garage. The patient had previously presented to the emergency department due to CO poisoning, where he complained of a headache, dizziness, nausea, and confusion. CO poisoning was confirmed by lab tests reporting increased carboxyhemoglobin levels in the blood.

Carbon Monoxide’s Interference with Oxygen Transport

Carbon monoxide disrupts oxygen transport by binding to hemoglobin in red blood cells, with an affinity approximately 240 times stronger than that of oxygen. This binding forms carboxyhemoglobin, which reduces hemoglobin’s capacity to transport oxygen. Consequently, the oxygen supply to vital organs is diminished, leading to tissue hypoxia and potential cellular damage, manifesting in symptoms such as those Lucas experienced (Patel et al., 2023).

Treatment Options for Carbon Monoxide Poisoning

Treatment for carbon monoxide poisoning primarily involves the administration of 100% oxygen via a non-rebreather mask, which helps displace carbon monoxide from hemoglobin, reducing the half-life of carboxyhemoglobin. In cases of severe poisoning, hyperbaric oxygen therapy (HBOT) is recommended. HBOT accelerates the dissociation of CO from hemoglobin, enhancing oxygen delivery to tissues. Supportive care is also critical, particularly monitoring for complications such as cardiac arrhythmias or neurological effects (Buboltz & Robins, 2020).

Factors Decreasing Hemoglobin’s Affinity for Oxygen

Hemoglobin’s affinity for oxygen decreases under certain physiological conditions, which include:

• Increased concentration of carbon dioxide (CO2): Higher levels of CO2, a byproduct of cellular metabolism, reduce hemoglobin’s affinity for oxygen through the Bohr effect, facilitating oxygen release to tissues.
• Lower pH: A decrease in blood pH (acidosis) also reduces hemoglobin’s affinity for oxygen, encouraging oxygen delivery to more acidic, metabolically active tissues.
• Increased temperature: Elevated body temperature, as seen during exercise or fever, decreases hemoglobin’s oxygen affinity, aiding in oxygen delivery to active tissues.
• Increased levels of 2,3-bisphosphoglycerate (2,3-BPG): 2,3-BPG is a compound produced in red blood cells that binds to hemoglobin, decreasing its affinity for oxygen and promoting oxygen release in tissues (Patel & Cooper, 2019).

Structural Components of Hemoglobin

Hemoglobin is present in the form of protein, which contains four chains, and each of the chains has a heme. Each heme group has a ferrous atom capable of binding to one oxygen molecule at its center. Human hemoglobin is composed of four polypeptide chains, namely, the alpha (α) chain and beta (β) chain, and there are two chains of both types in adult hemoglobin: HbA. The quaternary structure of hemoglobin is in such a way that the binding of one oxygen molecule enhances the probability of the other subunits in the hemoglobin molecule to bind with oxygen.

Oxygen-Carrying Capacity of Hemoglobin

Four (4)

Hemoglobin, being a tetramer, can bind four oxygen molecules, and each of the heme groups present in the hemoglobin can bind one oxygen molecule.

References

Buboltz, J. B., & Robins, M. (2020). Hyperbaric treatment of carbon monoxide toxicity. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470531/

Patel, A. K., & Cooper, J. S. (2019, October 27). Physiology, Bohr effect. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526028/

Patel, S., Mohiuddin, S. S., & Jose, A. (2023, March 27). Physiology, oxygen transport and carbon dioxide dissociation curve. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539815/

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BIOS255 – Week 7 Case Study

The respiratory system is a complex network of organs and tissues responsible for supplying oxygen to the body’s cells and removing carbon dioxide. However, exposure to certain gases, such as carbon monoxide (CO), can disrupt this delicate balance. CO binds to hemoglobin in red blood cells, preventing oxygen from reaching vital organs and tissues, leading to tissue hypoxia and cellular damage.

Carbon Monoxide Poisoning and Its Impact on Oxygen Transport and Hemoglobin Function

Patient Background:
Lucas, a 45-year-old man, is brought to the emergency department by his worried wife, Ava, and their teenage son, Michael. Earlier in the day, a powerful storm knocked out electricity in their neighborhood, leaving their home without power. Lucas, being the resourceful and proactive individual he is, decided to fire up the old gas-powered generator stored in their garage to keep the essentials running until the power was restored.

As the evening wore on and the storm showed no signs of letting up, Lucas remained in the garage, tinkering with the generator to ensure it continued to hum along smoothly. Unbeknownst to him, the generator was emitting a colorless, odorless gas that posed a grave danger to his health and well-being.

After several hours, Ava noticed that Lucas had not returned from the garage and went to check on him. She found him slumped over near the generator, complaining of a pounding headache, dizziness, and nausea. Alarmed, she immediately called for Michael for help.

Lucas, in a foggy haze of confusion, could barely muster the strength to lift his head as Ava and Michael guided him into the car. With each passing minute, his symptoms seemed to worsen, and Ava feared the worst as they raced through the rain-soaked streets to the emergency department.

Desired Outcomes:

1. Identify the underlying cause of Lucas’s symptoms and provide timely treatment.
2. Stabilize Lucas’s condition and prevent further complications associated with CO poisoning.
3. Educate Lucas, Ava, and Michael on the dangers of carbon monoxide exposure and the importance of proper ventilation when using gas-powered generators.
4. Ensure Lucas’s safety and well-being before discharge and follow up with appropriate referrals for continued care if necessary.

Findings:
Upon arrival at the emergency department, Lucas presents with a pale complexion, labored breathing, and confusion. Ava and Michael frantically explain the sequence of events to the attending physician, who wastes no time initiating a series of tests to assess Lucas’s condition.

Blood tests reveal elevated carboxyhemoglobin levels, confirming a diagnosis of carbon monoxide poisoning.

Questions:

1. Explain how carbon monoxide interferes with oxygen transport in the body.
2. What are the treatments for individuals with carbon monoxide poisoning?
3. Explain the factors that decrease hemoglobin’s affinity for oxygen.
4. What are the structural components of hemoglobin?
5. How many oxygen molecules can one molecule of hemoglobin carry when fully saturated?
6. 1
7. 2
8. 4
9. 8