Carbon monoxide is a common toxic agent.
It's usually culprit in suicide attempts
where people will breath in exhaust fumes from a car.
Carbon monoxide has an affinity for hemoglobin about
two hundred times greater than oxygen.
The threshold limit for a human is about 25 ppm in 8 hours.
Now, consider that on a bad traffic day in LA,
you're going to hit 100 ppm. In Mumbai India, you'll hit
400 ppm. And in Shanghai, you'll hit 800 ppm.
So, you can see that there is a toxicity potential
in terms of the environment.
Carbon monoxide results in a significant amount of confusion.
Sometimes, you can have decreased visual acuity.
There is almost always tachycardia. There may be syncope,
and eventually will result in coma and death.
The classic sign of a carbon monoxide patient
are those rose cheeks.
You see a person come in, and they have those red rose cheeks,
and they look like they're just a little bit hyperemic,
almost always you can diagnose carbon monoxide
just by looking at them.
The first time you see a carbon monoxide poisoned patient,
you'll almost never missed the next diagnosis.
The treatment is always with hyperbaric oxygen,
which is sometimes a problem in rural and remote areas.
Sulphur dioxide is an agent that is in the air
that sometimes can cause toxicity.
It forms sulfurous acid on contact with some
mucous membranes. 6 ppm will cause symptoms.
Generally, it's irratation of those mucous membranes. So, you
get conjunctival irritation and mucous membrane irritation.
A classic picture is a person with red eyes
and irritation of the nares or nasal cavity.
Long term exposure may lead to pulmonary edema.
And treatment is always supportive including
anti-inflammatories and high levels of oxygen.
Dioxin toxicity is an important consideration
on the chemical industry.
Many chemical agents rely on dioxin as an intermedia in
manufacturing. They are very poorly metabolized.
And why I mention it here today is because these dioxins
are very persistent in the environment.
They cause a wasting syndrome and they cause hepatotoxicity.
And they cause immune dysfunction and teratogenicity.
If you're practising it in an area,
where you start to see high levels of immune dysfunctions,
high levels of wasting and hepatotoxicity,
and even teratogenicity in a community,
the first thing you should be looking for
are dioxin levels in the environment.