The use of carboxyhaemoglobin percentage as a measure of severity of carbon monoxide poisoning, or to predict treatment options, is limited because carboxyhaemoglobin levels are affected by removal from the source of carbon monoxide and any oxygen treatment given before measurement of percentage carboxyhaemoglobin. Smokers are exposed to increased levels of carbon monoxide in cigarettes, and otherwise healthy heavy smokers can tolerate levels of carboxyhaemoglobin of up 15%. Interpretation of carboxyhaemoglobin levels: Non-smokers living away from urban areas have carboxyhaemoglobin levels of 0.4-1.0%, reflecting endogenous carbon monoxide production, whereas levels of up to 5% may be considered normal in a busy urban or industrial setting. The classical signs of carbon monoxide poisoning - described as cherry-red lips, peripheral cyanosis, and retinal haemorrhages - are rarely seen. In people suffering from co-morbidities, symptoms such as shortness of breath or chest pain may be more evident. The symptoms of carbon monoxide poisoning are non-specific and varied, and include headache, fatigue, malaise, "trouble thinking", confusion, nausea, dizziness, visual disturbances, chest pain, shortness of breath, loss of consciousness, and seizures. The signs and symptoms of carbon monoxide poisoning are mainly associated with the brain and heart, which are most sensitive to hypoxia. Although the diagnosis of carbon monoxide poisoning can be confirmed by detecting elevated levels of carboxyhaemoglobin in the blood, the presence of clinical signs and symptoms after known exposure to carbon monoxide should not be ignored. Carboxyhaemoglobin percentage is the most frequently used biomarker of carbon monoxide exposure. Diagnosis of carbon monoxide poisoning: Exposure to carbon monoxide is measured either directly from blood samples and expressed as a percentage of carboxyhaemoglobin, or indirectly using the carbon monoxide in expired breath. Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death.
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