Ep 227 Carbon Monoxide: Haunted houses & coal mine canaries

There is something uniquely tragic and terrifying about carbon monoxide poisoning. The way it comes on quietly, without warning. How it alters your reality and changes your behavior. The fact that without a carbon monoxide detector, we can’t smell or taste or see or otherwise sense this poisonous gas. Humans have been dealing with the threat of carbon monoxide poisoning since long before we were a species, and only recently have we developed the skills and knowledge to contend with it. In this episode, we get into the details of carbon monoxide poisoning - why it’s deadly, what symptoms look like, and how we manage cases - before delving into the history of our relationship with the gas. How many ghostly apparitions were actually instances of CO poisoning? What maritime mysteries can be explained by the presence of the gas? And where does carbon monoxide poisoning still remain very much an issue today? Tune in for all the details. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

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  From a post titled "Post-it Notes Left in Apartment", posted on the subreddit Legal Advice by rbradbury1920 in 2015. "On the 15th of April, I found a yellow Post-it note in a handwriting that wasn't mine on my desk, reminding me of some errands I had to do, but told literally nobody about. While odd, I chalked it up to something I did in my sleep, thinking maybe in my half-awake state I scrawled it, so it didn't appear to be my handwriting. I threw it out and thought little of it. On the 19th, I found another Post-it note on the back of my desk chair, in the same handwriting as the previous note, telling me to make sure I 'saved my documents.'

• 2:58Speaker 03

  I was freaked out, but there were no other signs of a break-in, so I set up a webcam in my house, aimed at my desk, and used a security cam app for it to record after detecting movement. On the 28th, I woke up to find another Post-it note, this one saying, 'Our landlord isn't letting me talk to you, but it's important we do.'" I immediately checked the webcam's folder on my computer and found nothing from the night before, but my computer's recycling bin had been emptied, which I am certain I did not do recently, indicating someone had noticed the webcam and deleted the files. They were just saved straight to a folder on my desktop called webcam. Today, on the 1st of May, I found another Post-it note, this time on the outside of

• 3:43Speaker 03

  my door, with nothing written on it. And there also appeared to be Post-its on many other doors in my apartment complex, all blank in varying colors. Do I have any legal recourse here? I have no proof, except for the Post-its, but those are written by my pen and on my Post-it notes, so conceivably, I could have faked them. Would contacting the police get me into any trouble if they can't determine an outside source for this? I just want to make sure I'm not wasting anyone's time. Should I consult my landlord, those also living in the complex?" Edit to the original post. "I pulled up a letter I received from my landlord back when I moved in, and the handwriting is identical. Could this count as evidence?"

• 4:23Speaker 03

  And then the top-voted comment from this Reddit thread is by a user called Cacralak. "You seem sincere, and this doesn't appear to be the plot of a Ray Bradbury short story. It's possible that your landlord is leaving notes inside your apartment, but they don't make any sense in the context you're describing them. It's likely that you are writing the notes yourself, but you are forgetting. Do you use Post-it notes as reminders in any other parts of your life or job? Yes, this might be a mental health issue. You might be experiencing some sort of dissociative disorder. Or it might be a physical problem. You mentioned that you have a very unusual, narrow bedroom with no windows. Is there a chance that you are not getting enough ventilation when you sleep, or that

• 5:06Speaker 03

  there is a carbon monoxide leak in the building? A cheap carbon monoxide detector, which you should have anyway, is a fast way to find out. You'll also have really bad headaches." In reply, Ray Bradbury1920, the original poster, wrote, "I have had really bad headaches, and I actually already do have a carbon monoxide detector. Guess I should probably take that out of its box and plug it in." And then, in an update post to "Post-it Notes Left in Apartment", "Thanks to everyone who sent suggestions and gave advice on how to proceed, especially to those who recommended a carbon monoxide detector, because when I plugged one in in the bedroom, it read at 100 parts per million."

• 6:36Speaker 03

  So this is like, from the Reddit Hall of Fame. I mean, I'm chronically online, so I think that like, this, when we decided to do carbon monoxide, this immediately popped into my head.

• 6:46Speaker 00

  Like, you already knew about this?

• 6:48Speaker 03

  Oh, yeah.

• 6:49Speaker 00

  2015, I mean, okay.

• 6:50Speaker 03

  2015, yeah.

• 6:53Speaker 00

  Fascinating. I still have so many questions. Like, why was the handwriting so different?

• 6:58Speaker 03

  Well, so I actually have an answer to that a little bit. So, there's another comment that said, "Hi, so on further inspection, the handwriting really doesn't match up. However, both documents were on the same desk as several printed typed documents, and next to the typed documents, the handwriting seemed so similar. Also, it wasn't even a letter from my landlord, it was a letter from my mom." And so I think there was just like, a lot of confusion, delusion happening.

• 7:22Speaker 00

  Just a lot going on.

• 7:23Speaker 03

  Yeah. And so, carbon monoxide poisoning.

• 7:26Speaker 00

  Carbon monoxide.

• 7:28Speaker 03

  The symptoms that it can cause are so strange and bizarre, that you're like, "This doesn't make sense, what's going on. I don't know how to put this into any sort of logical order." And oftentimes, like, I think that's one of the scariest things about carbon monoxide, is that your brain might not immediately go to carbon monoxide. It finds other explanations.

• 7:47Speaker 00

  Right. 100% not. Especially when you like, you don't have a reason to, initially.

• 7:53Speaker 03

  Right, right. So, yeah, that's from Reddit. I'll post a link to both the original posts and the update.

• 8:01Speaker 00

  And the update.

• 8:02Speaker 03

  Yeah. Hi, I'm Erin Welsh.

• 8:04Speaker 00

  And I'm Erin Allman Updike.

• 8:06Speaker 03

  And this is This Podcast Will Kill You.

• 8:08Speaker 00

  Welcome to carbon monoxide.

• 8:10Speaker 03

  To carbon monoxide.

• 8:12Speaker 00

  Well, clearly, this is gonna be a good episode, Erin. I'm already...

• 8:15Speaker 03

  I just like, there was, I also found several more firsthand, I mean, several more firsthand accounts, several more that were really tragic, because somebody was not recommended a carbon monoxide detector, or did not have one, or did not make the escape that the person in our firsthand account did. And it's just, yeah, there's a lot here. It's a, it's gonna be a strange history, for my part, anyway. I don't really know. But I'm excited to learn more about like, why it causes these, these strange symptoms that it does.

• 8:47Speaker 00

  Yeah, but I don't know that I'm gonna have that satisfying of an answer for you, but we'll talk about it.

• 8:51Speaker 03

  We'll talk about it, at least. But first, it's quarantine time.

• 8:55Speaker 00

  It's quarantine time.

• 8:56Speaker 03

  Well, what are we drinking this week?

• 8:57Speaker 00

  We're drinking Silent But Deadly. Which we're pretty sure we've never named a quarantine that before.

• 9:03Speaker 03

  We might have named like, an episode title this...

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  Maybe. That's possible.

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  That's possible. In any case, Silent But Deadly is a cherry milkshake.

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  Cherry milkshake. You'll know why. It will make sense.

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  It will make sense later.

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  Yeah.

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  We'll post the full recipe for Silent But Deadly on our website and all of our socials, so if you're not already following us there, you should be.

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  You should be.

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  Website stuff.

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  And on our website, it's there. ThisPodcastWillKillYou.com, we have a whole bunch of stuff there. Check it out. Heard this spiel before, everyone.

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  A million times.

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  Okay.

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  All right. No more business.

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  No more business.

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  Okay.

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• 12:44Speaker 00

  So carbon monoxide is a gas.

• 12:47Speaker 03

  Mm-hmm.

• 12:47Speaker 00

  It is made of one carbon and one oxygen. That's pretty obvious, I think. And it is the product of incomplete combustion of organic compounds. And I don't know a lot about combustion or anything like that. But basically, when we use anything that requires a fire, anything that burns, whether it's our cars, unless you have an electric vehicle, gas stoves, fireplaces, some portion of the combustible material is not going to completely burn into CO2 or carbon dioxide gas. And instead, it will form carbon monoxide.

• 13:25Speaker 03

  Okay.

• 13:25Speaker 00

  That's the limit of my combustion knowledge, okay?

• 13:29Speaker 03

  Great.

• 13:29Speaker 00

  This gas, carbon monoxide, is colorless. It is odorless. It is tasteless. And it's not irritating to our mucus membranes in any way, which means it is entirely undetectable by our human senses. And it is incredibly quickly and easily absorbed into our bloodstream when we inhale it, which is how we get exposed.

• 13:54Speaker 03

  Isn't it detectable by other animal senses?

• 13:57Speaker 00

  What a great question. I have literally no idea.

• 14:01Speaker 03

  Okay. I know that, like, other, I mean, any animal will experience symptoms of carbon monoxide poisoning, but I don't know if it has a smell for them. Fascinating.

• 14:10Speaker 00

  Yeah. Oh, that's a really interesting, I would have had to Google totally different things than I did.

• 14:18Speaker 00

  But we cannot detect it.

• 14:19Speaker 03

  Right.

• 14:20Speaker 00

  But I'm going to pause right there and take a couple of steps back. Because I feel like to understand the consequences of carbon monoxide poisoning, which is what we're talking about today, we actually first have to understand a little bit about how our body carries other gases, particularly oxygen and carbon dioxide. Because once we understand that, then we can understand why carbon monoxide causes so many of the consequences that it does when we get exposed to high levels of it. So I think everybody knows that we all need oxygen to survive. We, our cells, our tissues, we rely on oxidative metabolism. So we have to have oxygen.

• 15:03Speaker 00

  And as our body uses up that oxygen through metabolism, we create carbon dioxide. And then we have to release that carbon dioxide.

• 15:12Speaker 03

  Mm-hmm.

• 15:13Speaker 00

  So the way this works is that we breathe in oxygen gas to our lungs from the air. Deep in our lungs, past our trachea and our bronchi and our bronchioles, we get to these alveoli, which are these tiny, little grape clusters of air pockets that are surrounded by capillaries, super-thin, teeny-little blood vessels. In those little grape clusters, alveoli, the concentration of oxygen is going to be really high in that airspace. And the concentration of carbon dioxide in our blood is going to be high because this is all the blood that we used up and has traveled back to our lungs. So we have a switch where oxygen gets forced into our bloodstream,

• 15:56Speaker 00

  and carbon dioxide is released into the airspace so we can breathe it out. And the oxygen can continue on in our bloodstream to oxygenate all of our tissues. But like many things that we've talked about in our body, things in our bloodstream generally aren't just floating around in our bloodstream. And oxygen is no exception. It's not just dissolved in our bloodstream. Most of it actually gets attached to a protein called hemoglobin, which is part of our red blood cells. That's why our red blood cells are the thing that carries oxygen. This protein not only has to grab onto oxygen in our lungs, in the blood in our lungs,

• 16:39Speaker 00

  it then has to carry it to all of our tissues and release it at the right time and the right place so that that oxygen can get to where it needs to go. And then it, like, exchanges it for carbon dioxide and then comes back to our lungs.

• 16:54Speaker 03

  Right.

• 16:55Speaker 00

  So you can think of hemoglobin on our red blood cells like a truck that's carrying packages for delivery.

• 17:01Speaker 03

  Mm-hmm.

• 17:01Speaker 00

  And it has to do both things at the same time. It has to grab and hold onto oxygen really tightly to be able to carry it from our lungs to our tissues. And then it also has to release it. It has to let it go and deliver it at the right time and place so that our cells can use it. And our body does a really good job of this. We can actually map out these really interesting curves that we call oxygen dissociation curves.

• 17:27Speaker 03

  We talked about this in our high-altitude altitude sickness episode.

• 17:31Speaker 00

  Oh, yes. That feels right. That feels right. Because basically, what that tells us is the pressure of oxygen dissolved in our bloodstream versus the saturation of hemoglobin, how many oxygen molecules are packed on that truck.

• 17:45Speaker 03

  Right.

• 17:46Speaker 00

  And when our hemoglobin is going to hang on versus when it's going to release that oxygen.

• 17:50Speaker 03

  Mm-hmm.

• 17:51Speaker 00

  It depends on a whole bunch of things. pH, blah, blah, blah, CO2, temperature. Carbon monoxide screws this whole system up. Okay?

• 18:00Speaker 03

  It does. It does.

• 18:02Speaker 00

  Because what carbon monoxide does is it competes with oxygen for space on our hemoglobin molecules. So it literally, the trucks of our hemoglobin get packed with carbon monoxide preferentially because the affinity of our hemoglobin for carbon monoxide is over 200 times as great as it is for oxygen.

• 18:27Speaker 03

  Ooh, that's so bad.

• 18:28Speaker 00

  It's really bad. So if there's any carbon monoxide there, our hemoglobin is picking that up first before it loads any oxygen. All right? That's what that means. So first, that's the first problem, right? If you have carbon monoxide in your lungs, your hemoglobin is going to pick that up, which means that we are loading less oxygen onto our hemoglobin trucks. So less oxygen is going to be able to go through our bloodstream and make it to our tissues. But wait, there's more.

• 18:55Speaker 03

  Of course.

• 18:56Speaker 00

  In doing this, what also happens is that that oxygen dissociation curve that I talked about gets shifted. So that even though our hemoglobin is carrying oxygen, it will not give it up as easily if it's also carrying carbon monoxide.

• 19:15Speaker 03

  Okay, it wants to cling tightly to carbon monoxide, but it's clinging to everything.

• 19:21Speaker 00

  Everything. So even though it's like twofold, our trucks are not carrying as much oxygen. And once they get to the point of delivery, they're not offloading that oxygen as readily.

• 19:31Speaker 03

  Yep.

• 19:32Speaker 00

  So what that means is that when we are exposed, especially to high levels of carbon monoxide, our tissues end up literally starved of oxygen. And that is the main consequence that we see from carbon monoxide. You get the formation of these carbon monoxide and hemoglobin bonds, and that leads to hypoxia. Our tissues lack oxygen. It's not just hemoglobin. Carbon monoxide also binds to other proteins in our body that also contain that heme protein. So it's like the same protein, it's just on other things. One of them is myoglobin, which is a protein in our heart and our skeletal muscle. It does the same thing. It's binding to it and it's disrupting the way that it is supposed to work and leading to hypoxia.

• 20:15Speaker 00

  Carbon monoxide also binds to this enzyme called cytochrome C oxidase, which is involved in our mitochondrial function. Our mitochondria, the powerhouse of the cell, are, sorry.

• 20:28Speaker 03

  I'm finding you for that.

• 20:30Speaker 00

  But these are what literally produce energy. And so by carbon monoxide binding to this enzyme, we are literally reducing the amount of energy that we can produce, which further ends up causing hypoxia. Like, all of this ends up with our cells and our tissues are not able to function the way they're supposed to. We also see things like platelet activation. We see free radical formation. We see inflammation. So there's a lot of damage that happens to our tissues from hypoxia itself. And then from all these other downstream effects that are happening from carbon monoxide binding to stuff that it doesn't belong.

• 21:08Speaker 03

  Okay, how is it getting to these proteins?

• 21:11Speaker 00

  It's a great question. So because we are inhaling it, the same way that we inhale oxygen and nitrogen gas through the air, it is being forced into our bloodstream the same way that any other of these gases are.

• 21:24Speaker 03

  Okay, so it's just like there's loose molecules of carbon monoxide. And then when they find these different heme proteins or cytochrome C, then that's what happens.

• 21:31Speaker 00

  Then they're going to bind to it, yeah.

• 21:33Speaker 03

  So the other question I have is about, is twofold. Well, it's timeline of this. So like when these symptoms start to develop and then the concentration at which symptoms appear and resolution.

• 21:47Speaker 00

  Yeah.

• 21:48Speaker 03

  Is it cumulative? Is it chronic? You know, yeah.

• 21:52Speaker 00

  Yeah, these are all, these are all really, really good questions. And I don't have perfect answers for them. So carbon monoxide concentrations in our atmosphere, let's say just like outside or walking around or something like that. Typical atmospheric concentrations range anywhere from 0.03 to 0.2 parts per million. So it's there. We're always breathing it in, but at very low levels. One paper that I read suggested that in most households, so indoor air with adequate ventilation, if you do not have a gas stove, which is obviously going to be a potential source of carbon monoxide, then you're usually looking at like 0.5 to 5 parts per million in your house.

• 22:30Speaker 03

  Okay.

• 22:31Speaker 00

  If you do have a gas stove, but it's well ventilated, then we're talking maybe 5 to 15 parts per million in your house. One of the big ways that we look at like, how can we decide how much is too much? Or how much should we be exposed to? Is we look at like OSHA guidelines, which is Occupational Health and Safety Limits. The World Health Organization recommends in 24 hours, no more than seven parts per million should we be exposed to on average in 24 hours.

• 23:01Speaker 03

  So our first hand account, who had 100 parts per million?

• 23:03Speaker 00

  That's very high. The World Health Organization recommends that you should be exposed to 100 parts per million for no more than 15 minutes. Uh huh, okay. Now, the EPA through the United States of America has higher limits for workers. So they say that workers should be exposed to no more than 50 parts per million averaged over an eight hour workday with an upper limit of 200 parts per million over a 15 minute period. Now that's higher than the World Health Organization. Why? I don't know.

• 23:34Speaker 03

  Have those changed?

• 23:36Speaker 00

  That was the most recent, that's the, the World Health Organization paper that I read was actually a bit old.

• 23:41Speaker 03

  Okay.

• 23:42Speaker 00

  The OSHA is, was updated like this year. So the EPA recommendations. You've got links to all of that if you want to read more. But so anyways, so that's like how much we're exposed to. I have a really hard time understanding parts per million concentrations, because like it's not very meaningful to me. It's also not like that easy to say this many parts per million equals these symptoms in people, if that makes sense. Because the way that we're going to measure someone's exposure is actually by measuring the amount of carbocy hemoglobin. That is those hemoglobin molecules with carbon monoxide attached to them. And that level, first of all,

• 24:25Speaker 00

  varies drastically with time from exposure. So you could be exposed to a really high concentration, but within a few hours, your amount of that carbocy hemoglobin is going to drop. And other people, for example, people who smoke cigarettes are constantly being exposed to pretty high levels of carbon monoxide. So their blood levels of carbocy hemoglobin are actually quite high.

• 24:48Speaker 03

  Right.

• 24:49Speaker 00

  So typical blood concentrations in people who do not smoke range from 0.5 to 1.5% of your, like that's how much carbocy hemoglobin you have in your bloodstream.

• 25:01Speaker 03

  Okay.

• 25:02Speaker 00

  People who smoke really heavily might have up to 15% carbocy hemoglobin. Whereas people who smoke maybe one or two packs a day might be somewhere from like 3 to 8% carbocy hemoglobin. But most people are going to start to experience symptoms if their carbocy hemoglobin levels rise to about 10 to 15% or greater. That's for most people if they're not chronically exposed.

• 25:27Speaker 03

  If they're not chronically exposed.

• 25:28Speaker 00

  And the issue of chronic versus like acute exposure, we don't really have good data on that, which is really interesting, especially when you think about, like a carbon monoxide detector is generally detecting levels above that 100 or so parts per million, because that's the level at which we know for sure you can have acute carbon monoxide poisoning.

• 25:47Speaker 03

  I see.

• 25:48Speaker 00

  But it's not necessarily detecting 20, 30, 40, 50 parts per million, which over time could have effects. But, which is why the World Health Organization recommends that we not be exposed to that much. But we don't, we're not necessarily monitoring for that, if that makes sense, except maybe in an industrial context.

• 26:06Speaker 03

  Interesting. I don't know, I just assumed that carbon monoxide detectors would detect carbon monoxide. I mean, and they do, but like it's at a threshold. I guess I would have just assumed the threshold would be slightly lower.

• 26:20Speaker 00

  Yeah, most of that, I mean, it's going to vary by, you know, detector, of course, as well too. But in general, there, the point of a carbon monoxide detector, at least regionally, is to detect a level at which you need to get out of the house.

• 26:33Speaker 03

  You need to get out of the house.

• 26:34Speaker 00

  You need to do something, right?

• 26:35Speaker 03

  Okay, so then that leads me to another question, and that is diagnosis. So if somebody is, shows up to the ER and they have these symptoms and they don't know, for example, that they have been exposed to high levels of carbon monoxide, what do physicians look out for?

• 26:51Speaker 00

  Yeah, this is a really good and really important question. The way that we diagnose it is generally by measuring those carbocy hemoglobin levels, which means that you have to think of it and then you have to measure it. Let's talk about the symptoms, because we actually haven't yet. And you'll see why this can be such a really hard question, actually.

• 27:10Speaker 03

  Right.

• 27:10Speaker 00

  Because the symptoms are very nonspecific, especially in that acute exposure phase. So often, we're going to see headache. We're going to see nausea, maybe vomiting. We might see an increase in heart rate or sometimes an increase in breathing rate, which is kind of our body trying to compensate for that lack of oxygen.

• 27:30Speaker 03

  Yeah.

• 27:30Speaker 00

  Kind of pumping blood a little bit faster, forcing oxygen to our tissues. As the symptoms get more severe, meaning if you've been exposed either for longer durations or to higher concentrations of carbon monoxide, we can start to see pretty severe neurologic effects. So that might mean syncope, passing out. It might mean seizures. And it can end up meaning coma. And often, the reason that we see this is because the blood vessels in our brain become very dilated, in part directly due to the effects of carbon monoxide, which is a vasodilator. But also in part as our body trying to compensate, shunting as much blood as possible to this vital organ, our brain. But what happens when the blood vessels

• 28:15Speaker 00

  in our brain start to dilate is that like all blood vessels, they become leaky. And so that can lead to edema or swelling in the brain. So that is why we see such severe neurologic complications from carbon monoxide, both from lack of oxygen and from this swelling that happens in the brain. We also see a lot of effects on the heart, because again, lack of oxygen, your heart needs a lot of oxygen. And because carbon monoxide is going to be attaching to the myoglobin itself. So it's going to be causing direct damage to the heart cells, to the heart muscle. And so we can see arrhythmias. We can see things that look like heart attacks. So ischemia to different parts of the heart, even though you don't have any blockage in your arteries. It's just from the carbon monoxide.

• 29:00Speaker 00

  And so then people can die from things like cardiac arrest as well, too. Often, we can see that some things like motor function can start to be impaired slowly and before you have like loss of consciousness. So someone might notice like, things feel off. I don't feel right, but I'm not able to like move fast enough. I'm not able to do the things that I need to do to improve ventilation, to get myself out of this situation. And it's because of just overall the effects that this carbon monoxide is having. The things that you learn in medical school about how to pick out carbon monoxide poisoning from anything else actually don't happen all that often because what we learn in medical school are cherry red lips.

• 29:45Speaker 03

  Right.

• 29:45Speaker 00

  Hence the cherry milkshake for our quarantini. We also see cyanosis or like purple or blue extremities, fingers, lips, toes, things like that. And then sometimes hemorrhages in the eye or in the retina. But even those are not that specific and they're certainly not happening in all cases of carbon monoxide poisoning. So it can be really difficult in the emergency room or in, you know, an office setting to know and to think of, could this be carbon monoxide? So it really comes down to exposure. Most commonly, people are exposed in something like a fire. So that you're going to have paramedics on scene who hopefully are going to be able to detect carbon monoxide with devices at the scene and know what the levels were there.

• 30:29Speaker 03

  Right.

• 30:30Speaker 00

  But it can be really hard in other circumstances, like, like in the firsthand account where it was this chronic exposure, it's a, that would be a lot trickier to actually detect in an emergency room setting.

• 30:40Speaker 03

  Which is very scary.

• 30:43Speaker 00

  Yeah, it's really scary.

• 30:44Speaker 03

  Because there's not like these, especially if somebody came to the emergency room, if that person went to the emergency room and said, without knowing they were exposed to carbon monoxide and said, my landlord's leaving Post-It notes.

• 30:55Speaker 00

  They would say, you're having a, you're having a psychotic episode. Well, and here, this is a yet another interesting thing that can happen from carbon monoxide exposure, whether acute or chronic. And again, we don't have great data on like chronic exposures or, or what level constitutes, et cetera, et cetera. But after an exposure to high levels where you have carbon monoxide poisoning, right? You're sick enough, you go to the emergency room, something bad happens. Even if you recover, something like 10 to 40% of people actually end up having delayed onset neuropsychiatric symptoms.

• 31:30Speaker 03

  Really?

• 31:31Speaker 00

  This could mean depression, this could mean Parkinsonism, this could mean dementia, this could mean psychosis. And we don't really understand who this is going to happen to, why exactly this is going to happen, or like what, is it a specific level of exposure? Is it a time of exposure? Like, we really don't understand these delayed cognitive and neuropsychiatric effects that we see, but they are definitely a thing that is real and that happens.

• 31:58Speaker 03

  Huh.

• 31:59Speaker 00

  Yeah.

• 32:00Speaker 03

  And how is this treated?

• 32:01Speaker 00

  Oh, great question. Oh, the only treatment that we have is oxygen. And what oxygen is going to do is by forcing 100% oxygen into your lungs, you increase the concentration of oxygen and literally just try to outcompete carbon monoxide on your hemoglobin. So if you are just breathing regular room air, which is like 20% oxygen, then the half-life of carbon monoxide on your hemoglobin is usually about four to six hours. So you will eventually get rid of all that carbon monoxide. If you're breathing 100% oxygen, then that decreases the half-life to about 40 to 80 minutes. So you can offload that carbon monoxide a lot faster.

• 32:45Speaker 00

  When people have a really severe symptoms, either really high levels of carboxyhemoglobin above like 30, 40, 50%, or if they are comatose from exposure to carbon monoxide, or if they're pregnant, because pregnant people are at particularly high risk of carbon monoxide poisoning, the fetus specifically is at really high risk of hypoxia from this. It's because of their fetal hemoglobin, it's interesting, but too much.

• 33:12Speaker 03

  Oh, yeah, yeah, yeah.

• 33:12Speaker 00

  Because it already doesn't give up oxygen as easily.

• 33:14Speaker 03

  That's right, that's right.

• 33:16Speaker 00

  So at a lower level of carboxyhemoglobin, if you're pregnant, then you might be recommended to get hyperbaric oxygen, which we talked about in one of our episodes. Wounds, maggots?

• 33:27Speaker 03

  Wounds, maggots.

• 33:28Speaker 00

  Something like that.

• 33:29Speaker 03

  It wouldn't have been the bends, right?

• 33:31Speaker 00

  Yeah, probably was.

• 33:33Speaker 03

  Okay.

• 33:34Speaker 00

  Of course it was, Erin. So, yeah, so hyperbaric oxygen essentially is, is even further increasing the amount of oxygen that we're forcing into your lungs. And so in those cases, we can actually decrease the half-life to like 15 to 30 minutes and push off that carbon monoxide a lot faster.

• 33:53Speaker 03

  Okay.

• 33:53Speaker 00

  But that's if you have access to a hyperbaric oxygen chamber, which not everyone does.

• 33:58Speaker 03

  Right.

• 33:59Speaker 00

  But that's the only treatment. We don't have anything else.

• 34:02Speaker 03

  Okay.

• 34:02Speaker 00

  We don't have any other way to like metabolize the carboxyhemoglobin or any other drugs or medications. It's just oxygen.

• 34:10Speaker 03

  Whoa.

• 34:11Speaker 00

  I know, I know. And that's carbon monoxide, Erin.

• 34:16Speaker 03

  I, I, I mean, honestly, I just want to keep hearing about the numbers and stuff like that, but I should tell you about the history.

• 34:23Speaker 00

  Please, would you, please?

• 34:24Speaker 03

  I will, I will.

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• 38:06Speaker 03

  Haunted houses, coal mine canaries, mysterious maritime disasters. The history of carbon monoxide is steeped in tragedy, where fables teach cautionary tales about lighting a fire without ventilation, or communing with demons, and science shines a light on the previously unexplainable. From the dawn of fire, which we learned in our first burns episode was about 400 million years ago, creatures have been contending with the threats posed by carbon monoxide intoxication. And in the case of humans and our hominid ancestors, that means as long as we've been controlling fire, perhaps as long as one and a half million years, we've not only had

• 38:48Speaker 03

  to deal with burns, but also this potentially toxic compound as well, especially if burning a fire in an area with poor ventilation, such as caves.

• 38:57Speaker 00

  Yeah.

• 38:58Speaker 03

  Where, which were great, you know, residences for our ancestors.

• 39:02Speaker 00

  100%. Yeah, you're protected from the weather, and then you are exposed to carbon monoxide.

• 39:07Speaker 03

  Yeah, I read a short little note to the editor in a science journal that pondered whether artists of cave paintings, like those in the Pyrenees in France and Spain, may have suffered the negative effects of carbon monoxide as they worked on their masterpieces, because lighting was provided by the only available source, which was fire.

• 39:24Speaker 00

  Fire. Fascinating.

• 39:26Speaker 03

  Isn't that really interesting?

• 39:27Speaker 00

  That is really interesting.

• 39:28Speaker 03

  Yeah. I mean, surely, humans or our ancestors quickly grew aware of the hazards of fires in close quarters, but since carbon monoxide is colorless, odorless, tasteless, what did they think that it was?

• 39:42Speaker 00

  Right.

• 39:44Speaker 03

  Ghosts, gods, evil spirits. I mean, many cultures hold beliefs that on very cold nights, where you might be burning a larger or more intense fire than usual, demons, that's when demons come to carry away the very young and the very old.

• 39:58Speaker 00

  Huh.

• 39:59Speaker 03

  There are ancient Greek and Roman scholars that had their own theories and made their own recommendations. So Aristotle wrote that, quote, "Coal fumes lead to heavy head and death," end quote. And Hippocrates recommended sleeping in a large room so that you could breathe purer air, rather than a smaller room, which was more likely to fill with toxic smoke and fumes from heating sources. So like, this was kind of, I mean, common knowledge, in a way.

• 40:24Speaker 00

  Interesting.

• 40:25Speaker 03

  Lung damage, neurotoxicity, disturbance of motion, and death were also all noted as potential side effects of coal fumes by ancient Roman scholars. And in the 11th century, the famous Persian physician Avicenna described the paralysis that can result. And by the late 1500s, other hallmark symptoms like fever, vomiting, and cherry red skin had been noted by various scholars. I mean, I didn't include any of this in my notes, but I read an article that was really, really tragic. It was about a family that had experienced carbon monoxide poisoning, they had called 911. It turns out, other people in the hotel where they were staying had also called 911, and so the wrong family was taken away, or the other, a different family was taken away anyway.

• 41:09Speaker 03

  But they all called because they thought, we have the flu. Like, we're all vomiting, we have fevers, we feel nauseous, this, we have the flu. Anyway, but like, it just shows how easily it can be mistaken for other things.

• 41:23Speaker 00

  Right. Especially if you don't, like, I think we think of it if there is a gas fireplace, or something that is like actively burning, but if there's not that, then why would you think of it? Right?

• 41:35Speaker 03

  Yeah. When there's no smoking gun.

• 41:38Speaker 00

  Right.

• 41:38Speaker 03

  Yeah.

• 41:39Speaker 00

  Yeah.

• 41:40Speaker 03

  But unfortunately, all of this knowledge, the knowledge we have today, as well as the knowledge that these, you know, ancient scholars had, it came at a cost. So in order to describe the symptoms of carbon monoxide poisoning, people had to, of course, experience the poisoning. So for example, the bright red skin sign, or the bright red lip sign was noted as indicative of carbon monoxide in 1570, after a group of inmates had tried to escape by melting the prison bars, but instead, a wooden frame caught on fire, and they died of the resulting smoke. And it is also, I should also note here that like, people weren't calling this carbon monoxide poisoning. It was more like, these symptoms appear due to the negative effects of being exposed

• 42:23Speaker 03

  to coal fumes, or fumes from fire.

• 42:26Speaker 00

  Right, right, right, right. And, and it's probably, I didn't even mention this, but like, when it's fire, there's a lot of other things going on besides only carbon monoxide.

• 42:33Speaker 03

  Yes, yeah. There were many isolated incidents, as there are today, you know, individual cases, or household cases, but there were also larger scale tragedies over history, like leaks in heating systems in Roman bathhouses that caused deaths by suffocation of those who were in there. And these cases were not all solely accidental. So Hannibal's armies around 200 BCE reportedly executed Roman prisoners with carbon monoxide. And in fact, carbon monoxide poisoning was not an uncommon form of capital punishment.

• 43:09Speaker 00

  Whoa.

• 43:10Speaker 03

  So, quote, "The greenest possible wood capable of producing the most smoke." That was like, the methodology for execution.

• 43:18Speaker 00

  Geez, that's dark.

• 43:19Speaker 03

  And it was also commonly used as a method of suicide, including possibly by Cleopatra and by Roman philosopher Seneca. So people were using carbon monoxide, or more specifically, the toxic fumes from coal and other fires, intentionally to cause harm and death. But there still persisted a belief that supernatural forces were behind the poisonings.

• 43:42Speaker 00

  Interesting.

• 43:42Speaker 03

  Which, honestly, it's totally understandable. It is, given our firsthand account, like, that sounds like a haunting.

• 43:48Speaker 00

  100%. Yes.

• 43:50Speaker 03

  There's this handwriting, or it sounds like something nefarious is going on.

• 43:53Speaker 00

  Yeah.

• 43:54Speaker 03

  Heating sources were ubiquitous, right? You gotta have heat. And people weren't getting poisoned all of the time, and so, cause effect was more difficult to tease apart.

• 44:03Speaker 00

  Yeah, you can't just say one to one.

• 44:05Speaker 03

  Right. When was lighting a fire or a lamp okay, and when wasn't it? And so, stories of death that in retrospect could be ascribed to carbon monoxide poisonings were often told to teach like, a moral lesson, or to prove the existence of ghosts, or just give people the heebie jeebies. So take, for example, this story from Germany in 1715. A student, it's like, it's one of these like legends, right? A student promised a couple of farmers that he'd share a treasure with them, on the condition that they come with him on Christmas night to a little hut in a vineyard. And at midnight, the student would call to the spirits to tell him where the treasure was buried, and then they would all dig it up together.

• 44:46Speaker 03

  But Christmas, Germany, wintertime, pre-climate change, things were pretty cold. And so, it was getting very, very, very chilly. So the three of them lit a fire in this hut to warm themselves as they waited for the spirits to arrive. Whether they communed with the spirits remains a mystery, because none of the three survived to tell their tale, their version of events.

• 45:09Speaker 00

  Dun, dun, dun.

• 45:10Speaker 03

  They were all found dead the next morning.

• 45:12Speaker 00

  Wow.

• 45:12Speaker 03

  And we know today that carbon monoxide poisoning from the fire was a likely culprit. But at the time, and for years after, the story was told as a cautionary tale, that evil and death awaits those who call upon the devil.

• 45:25Speaker 00

  Hmm. Interesting.

• 45:28Speaker 03

  So there's a, there's a, it's a fable, kind of. It's like, there's a moral, moral meaning to it.

• 45:32Speaker 00

  Yeah.

• 45:33Speaker 03

  The belief that malevolent spirits caused these deaths was so widespread, even apparently among the medical establishment, that German physician Friedrich Hoffman felt it necessary to publish a paper on this case, and he was anonymous, he like, wrote it anonymously, where he outlined the effects of carbon monoxide, or smoke, you know, the hazardous smoke, and denied that there was any involvement by the devil. Quote, "Polluted vapors suppress the influx of clean air, and if man or animal has breathed this type of polluted air, he may faint, and if not helped immediately, suffocates for lack of air, because the sensation is that of strangulation, or like drowning in water," end quote.

• 46:15Speaker 03

  Mining deaths, which mining is one of the oldest professions, were also attributed to malicious supernatural spirits over the ages, and miners would pray or fast to try to protect themselves from demonic harm. So when Joseph Priestley discovered carbon monoxide in either 1772 or 1796, there seems to be some disagreement on what counts, it doesn't matter.

• 46:40Speaker 00

  Okay.

• 46:41Speaker 03

  It came at a time when interest in chemistry and physics and the natural sciences was mounting. And Priestley's works on carbon monoxide were in, it was in no way an isolated event. Several scientists either picked up on his research where he left off, or were simultaneously working on teasing apart the different characteristics of the compound, including those that made it toxic to humans and other animals. In 1800, William Kriechenk resolved the formula of carbon monoxide, and gave it its name, gaseous oxide of carbon. And it was only later, starting around 1879, that carbon monoxide began to be used, by which time, the pathophysiology of carbon monoxide poisoning had largely begun to be figured out.

• 47:26Speaker 00

  Okay.

• 47:27Speaker 03

  Pinning down what exactly carbon monoxide was, how it worked, and the settings leading to exposure, it helped to shed light on past mysteries, such as what exactly had happened to the English sailor Sir Hugh Willoughby, and the 62 men who traveled with him on the Bona Esperanza and the Bona Confidencia in 1553, to find the Northeast Passage. You know that I love a maritime disaster.

• 47:52Speaker 00

  You love a maritime disaster, especially like- The north.

• 47:56Speaker 03

  The north. I mean, the terror is like peak. Yeah, just I'm fascinated by it. But yeah, so this he, this, this captain and his 62 men all perished. They found the ship and the bodies. And they were like, people who first found it were like, I think it was exposure. I think it was scurvy, you know, things that did happen. But exposure deaths actually seem to be fairly rare. Scurvy deaths were certainly not, but like.

• 48:23Speaker 00

  But it wouldn't have happened all at once.

• 48:24Speaker 03

  Exactly.

• 48:25Speaker 00

  Scurvy isn't like a mass killer.

• 48:28Speaker 03

  It's not like a massive onset, right? And then everyone just dies at once.

• 48:32Speaker 00

  Right. It would be like people, yeah.

• 48:34Speaker 03

  Yeah.

• 48:34Speaker 00

  See our scurvy episode.

• 48:35Speaker 03

  See our scurvy episode. It's one of our faves.

• 48:38Speaker 00

  It is.

• 48:38Speaker 03

  But yeah, so there was a more recent hypothesis, I think, actually, just like a few decades ago, that placed the blame for their sudden and near simultaneous death on carbon monoxide. They're trying to stay warm in the frozen winter months. I don't know if, I think they were like locked in the ice. Light a fire inside this cabin. It's well sealed because it's a ship.

• 48:57Speaker 00

  Right? And then everyone.

• 48:58Speaker 03

  Yeah.

• 48:59Speaker 00

  Yeah?

• 49:00Speaker 03

  And carbon monoxide and understanding its pathophysiology, it provided a scientific explanation for paranormal encounters.

• 49:08Speaker 00

  Hmm.

• 49:09Speaker 03

  A famous example of this is the 1913 Science article, like article published in Science, titled "An Investigation of a Quote Unquote Haunted House." The author, Franz Schneider Jr. from MIT, he was called to a house in Boston, which was, quote, "acquiring an unfortunate and annoying reputation as being haunted," end quote. "The occupants of the house, who lived on the third and fourth floors, described strange sensations and sounds that kept them from sleeping throughout the night, especially on cold evenings." Quote, "It was said to be a common occurrence for servants to awaken the night with a sensation of oppression, as if someone were tapping upon me,

• 49:51Speaker 03

  or with a creeping feeling going all over me with a feeling of being paralyzed," end quote. Sounds like a haunted house.

• 49:58Speaker 00

  Sounds like a haunted house to me.

• 50:00Speaker 03

  They experienced delusions, like one of the children rushed into the nurse's room, saying that a man woke him up and scared him.

• 50:06Speaker 00

  Ooh.

• 50:07Speaker 03

  And the children were slow moving and pale in the morning and were more and more difficult to rouse with cold water. This had been going on for a couple of months, that the family had been living there. They were just recent tenants. And apparently, the previous tenants also experienced similar occurrences, lending support to the haunted house notion. Everyone who comes to stay here experiences someone creeping into their room at night.

• 50:31Speaker 00

  So it has to be the house.

• 50:33Speaker 03

  It has to be the house.

• 50:34Speaker 00

  Yeah.

• 50:35Speaker 03

  When the author arrived at the house to trace the origin of what he suspected was a gas leak, he found a, quote, "viciously defective hot air furnace," end quote, leaking loads of gas and carbon monoxide. And at the end of the article, he says that this case should be interesting to those investigating psychic phenomena, since the haunting at this house was readily explained by the inhalation of carbon monoxide.

• 51:00Speaker 00

  Yeah.

• 51:00Speaker 03

  And another great example, just because like I, I've heard this before, that like so many haunted houses can be explained by carbon monoxide.

• 51:08Speaker 00

  That's so interesting, Erin. I don't think I knew that.

• 51:11Speaker 03

  And I don't know how many of them actually were. There's a, there's an interesting paper I read too, that was like, let's look at the environment, like the environmental epidemiology or something of haunted houses and what it could be. How does humidity play a role? How does carbon monoxide play a role? Temperature, things like this.

• 51:29Speaker 00

  All the different things.

• 51:30Speaker 03

  Mm hmm. But so then I, yeah, I tried to like find more examples. So there was another one in 1921, a paper in the American Journal of Ophthalmology, titled "Effects of Carbon Monoxide Upon the Eye," by W. H. Wilmer. And he details a very similar case of a haunted house. Hearing things go bump in the night, listless children, seeing apparitions, feeling like someone was sitting on their chests as they slept. The previous tenants experiencing the exact same symptoms. And it was all traced to carbon monoxide poisoning.

• 52:03Speaker 00

  Fascinating, Erin.

• 52:05Speaker 03

  So how many haunted houses or paranormal experiences then and now can be explained by carbon monoxide?

• 52:12Speaker 00

  Yeah.

• 52:12Speaker 03

  More than a few. If you think you are living in a haunted house, buy a carbon monoxide detector.

• 52:17Speaker 00

  This is not a medical advice podcast, but everyone should have carbon monoxide detectors.

• 52:21Speaker 03

  Yes, yes.

• 52:23Speaker 00

  Yeah.

• 52:23Speaker 03

  Understanding carbon monoxide and the risks that it posed, it helped not only to explain these mysterious occurrences, but also to intervene and prevent further harm or poisoning from happening in the first place. So by the early 20th century, carbon monoxide had earned a deadly reputation among the general public, referred to by a couple of scientists as the, quote, "Frankenstein of civilization, the automaton that turns on its maker, pursues him to the ends of the earth and finally destroys him," end quote. It's a little dramatic.

• 52:54Speaker 00

  That feels extreme.

• 52:56Speaker 03

  Well, I think it was like, so if you think about this time, cars were becoming to be more of a thing. And so the exhaust that was produced inefficient.

• 53:04Speaker 00

  The carburetors or whatever it's called?

• 53:07Speaker 03

  Sure.

• 53:08Speaker 00

  There's something in cars now.

• 53:09Speaker 03

  I don't know enough about the history of cars.

• 53:10Speaker 00

  Catalytic converter. That's what it is.

• 53:12Speaker 03

  Catalytic converter, yes.

• 53:12Speaker 00

  That was before catalytic converters. And now they're much, they burn much cleaner, even though they're still terrible.

• 53:17Speaker 03

  They're still, yeah, there's still carbon monoxide. But like then it was like, we are poisoning our planet. And so it is, it was like a huge, yeah.

• 53:26Speaker 00

  Okay, that makes more sense now.

• 53:27Speaker 03

  Yeah. The Frankenstein.

• 53:30Speaker 00

  The Frankenstein.

• 53:31Speaker 03

  But public awareness could only go so far, right? And precise diagnostic tools and at home affordable carbon monoxide detectors were still decades away. I think specifically is the 1970s is when diagnostic tools emerged. And the 1990s is when at home carbon monoxide detectors became more readily available.

• 53:49Speaker 00

  Okay, that's recent.

• 53:51Speaker 03

  And so carbon monoxide poisoning was, were still quite common and quite deadly, especially in industrial settings like mining, where high concentrations of deadly gases could be found. And finding fresh air to escape the carbon monoxide was much more difficult than if you were just on the surface and you could leave the room, leave the house. You're trying to go up, up, up. Yeah. Hundreds of miners died every year in caverns and explosions and from exposures to deadly gases like carbon monoxide. And in the later decades of the 1800s, increasing rates of industrialization brought things to a fever pitch. There had to be some way to mitigate at least some of these dangers. Enter the pit canary.

• 54:36Speaker 03

  Canaries had been a popular pet since at least the 1500s throughout Europe, brightening any home with its lovely little singing voice. But in the mines, these birds offered more than companionship. They saved lives. Bird respiration is really fascinating and is quite different than mammal respiration. The long and short of it, I was like, should I explain bird respiration?

• 55:00Speaker 00

  How deep are we gonna get?

• 55:02Speaker 03

  Yeah, I don't think I'm equipped to. The long and short of it is that the way that it works is that these birds are very, very efficient at taking in oxygen. More efficient than we are with our mammal lungs.

• 55:14Speaker 00

  Okay.

• 55:14Speaker 03

  And that also makes them super efficient at taking in airborne toxins, such as carbon monoxide. And so if carbon monoxide is present, a canary, a bird, will show signs of poisoning before a human will.

• 55:26Speaker 00

  Right.

• 55:27Speaker 03

  Acting as kind of like an early carbon monoxide detector. In a grim, grim way.

• 55:32Speaker 00

  Very grim.

• 55:32Speaker 03

  Yeah. To give you a sense of timing, apparently, it was reported that a canary would faint or fall off its perch about 20 minutes before a human would faint.

• 55:42Speaker 00

  Hmm, that's enough time to run away.

• 55:45Speaker 03

  It's enough time to run away. And also, these birds were not just seen as these like detectors, these like, they were loved. They were beloved by their, by the miners.

• 55:55Speaker 00

  You have talked about canaries on this podcast before, because I remember you talking about how much the miners loved them.

• 56:02Speaker 03

  What? I don't remember this, Erin. Oh, no.

• 56:06Speaker 00

  I wonder, was it the bends or was it? It couldn't have been the bends. I don't remember what, someone who knows our podcast better than we do, what episode was it? Because I swear, the thought of you talking about miners and specifically that they loved these canaries and they weren't just like these throwaway things. I remember you talking about this.

• 56:25Speaker 03

  I'm gonna go to our transcripts right now and see if I can search this, because this is gonna. I genuinely have, I mean, like, my memory is so bad when it comes to this podcast. I'm like, did we cover things?

• 56:35Speaker 00

  Am I, am I, am I, what do you call it, manufacturing memory?

• 56:39Speaker 03

  I don't see anything in our transcripts. But oh, maybe they're not all there. I don't know, Erin.

• 56:43Speaker 00

  I don't know either.

• 56:44Speaker 03

  Let us know if somebody finds it.

• 56:45Speaker 00

  I love this. Keep going.

• 56:47Speaker 03

  Okay, so yeah, these canaries were beloved by these miners. And so if a bird did faint, it wasn't just, oh, my gosh, I gotta save myself. Of course, it was that, but it was, let's go revive the canary. And so they like had these little revival devices that they had also with them.

• 57:05Speaker 00

  I did not know that.

• 57:06Speaker 03

  It's really, yeah, it's really cute. And so officially, the first recommendation for the use of canaries in coal mines came in 1894 by J. S. Haldane, after a Welsh mining disaster in which both miners and volunteer rescuers died from carbon monoxide poisoning. But based on other writings and references to these birds in coal mines, it's likely that they were used possibly since the early 1800s. But yeah, miners grew quite attached to these creatures. Like I saw a picture of one tiny coffin. It was inscribed with "In memory of Little Joe, died November 3rd, 1875, aged three years."

• 57:44Speaker 00

  Oh, my gosh.

• 57:45Speaker 03

  I know. It made me wanna cry. And yeah, these little resuscitation chambers, there's also a picture of these that are really, really, it's just incredible. Some mining companies constructed aviaries on site to breed canaries for the mines. And these birds were used as late as the 1980s.

• 58:04Speaker 00

  Really?

• 58:05Speaker 03

  Until they were phased out as more precise electronic monitoring devices were introduced. Also, it was like, we're not gonna put these creatures.

• 58:14Speaker 00

  Or I mean, animal rights, et cetera.

• 58:15Speaker 03

  Yeah, to the, yeah, into these situations.

• 58:18Speaker 00

  Right, right, right.

• 58:19Speaker 03

  And so nowadays, the canary in the coal mine only exists as a useful phrase. Reports of fever of unknown origin, coral reef bleaching, you get the idea. Like, these are all the canaries in the coal mines signifying what's to come.

• 58:31Speaker 00

  Exactly.

• 58:32Speaker 03

  This summer is a canary in the coal mine for.

• 58:34Speaker 00

  A hundred percent. All of the fires burning around the entire world right now.

• 58:37Speaker 03

  Yes, yep. But once upon a time, these birds were really the only thing standing between a miner and disaster from carbon monoxide. Over the course of the 20th century, deaths due to carbon monoxide fell, actually, quite a bit, in part due to a broader switch from coal to natural gas, as well as improvements in treating poisonings, better diagnostics, and greater public awareness. Awareness is such a critical component of this.

• 59:05Speaker 00

  It's huge, huge.

• 59:07Speaker 03

  Yes. And of course, these poisonings have not disappeared entirely, as you're about to tell us, Erin, and many lives could be saved by installing monitoring devices in homes and workplaces. But as overall poisonings fell, there simultaneously was a growth in the possible benefits of carbon monoxide, like how can we use it to treat cancer or inflammation? I don't know if you're going to talk about any of these things.

• 59:33Speaker 00

  That was my ending, because it astounded me, Erin.

• 59:36Speaker 03

  Yes, me too. Okay, so I was like, I hope that Erin's going to talk about this, because I have no other way to end this like hodgepodge of history for carbon monoxide. So turn it over to you, Erin.

• 1:00:14Speaker 00

  Let me tell you about the terrible things first, Erin.

• 1:00:18Speaker 03

  Okay.

• 1:00:18Speaker 00

  And that is that carbon monoxide remains one of the most common causes of morbidity due to poisoning, not just in the US but around the globe. One paper that I saw out of Japan said that carbon monoxide poisoning counts for over half of the total number of poisoning deaths every year in Japan.

• 1:00:35Speaker 03

  Whoa.

• 1:00:36Speaker 00

  In the US, many years ago, it was reported that there was around 600 accidental deaths due to carbon monoxide every year. However, intentional deaths due to carbon monoxide are five to 10 times higher. There are up to 15,000 cases of carbon monoxide poisoning that are intentional every year, which is so devastating. And a paper from 2017 estimated that there's about 50,000 cases total of carbon monoxide poisonings in the US every year, with mortality rates that still remain between 1 and 3%. So overall,

• 1:01:16Speaker 00

  mortality rates have been on the decline globally for carbon monoxide mortality, but the rates of poisonings have actually been fairly stable for the last several decades. And they tend to be highest overall in low and middle income countries, and mortality rates are also much higher in low and middle income countries, where people are often cooking over, say, open fires, or just have less fuels that burn less cleanly, so that they produce a lot more carbon monoxide. So things like natural gas and propane produce a lot less carbon monoxide than things like coal, or firewood, or gasoline, and things like that.

• 1:01:58Speaker 03

  Yep.

• 1:01:59Speaker 00

  So this is definitely still a huge issue worldwide. And like you said, Erin, prevention and public awareness are some of the most important things, because we don't have any treatments for carbon monoxide poisoning, other than access to oxygen, which requires access to a hospital.

• 1:02:17Speaker 03

  Right.

• 1:02:18Speaker 00

  So that means things like inspection and maintenance of appliances. That means things like ventilation for any kind of device that is going to have fire. And it means the knowledge that when things get cold, when their, you know, power goes out and things like that, that gas-powered devices are not safe to be used indoors, because we see, especially in northern latitudes, when things get cold, people bring space heaters, gas power generators, and things like that indoors, and then we see accidents because of that.

• 1:02:50Speaker 03

  Yeah, yeah.

• 1:02:52Speaker 00

  So that is where carbon monoxide poisoning stands today. But I learned something new, Erin, which you mentioned, and that is that people are really interested in using carbon monoxide for good, as a therapeutic.

• 1:03:07Speaker 03

  Astonishing.

• 1:03:08Speaker 00

  It is astonishing. So the reason that people started to think about this and figure this out is not just because of carbon monoxide poisoning, but is actually because our body at baseline produces small amounts of carbon monoxide. We produce carbon monoxide actually through the breakdown of heme, the protein on hemoglobin that carries carbon monoxide. And it's not because it's carrying carbon monoxide, it's just because when you break it down, you get iron and bilafidin and carbon monoxide. Okay.

• 1:03:36Speaker 03

  Okay.

• 1:03:37Speaker 00

  And it turns out that we probably use carbon monoxide, or the function of carbon monoxide in our body at low levels, like the amount that we're producing, which is very low compared to what you're getting if you, you know, inhale a lot of carbon monoxide from an unventilated source of fire, is very similar to nitric oxide, which we also produce, and is used already in therapeutics for things like pulmonary hypertension for, you know, preemie babies and things like that. But basically, carbon monoxide can act as a vasodilator.

• 1:04:12Speaker 03

  Okay.

• 1:04:13Speaker 00

  It can also affect our, like, inflammatory cascade and our inflammation system. It's potentially also used in our bodies endogenously as a neurotransmitter. So there is a lot of interest in using this for the treatment of a lot of vascular diseases, for the treatment of inflammatory conditions, and just like, just the idea that we could use something that I have only ever thought of as a poison.

• 1:04:45Speaker 03

  Yeah.

• 1:04:46Speaker 00

  As a therapeutic is super fascinating. As far as I could tell, it's still like very early stages. I saw like a phase one trial, and that's about it. So I don't know that it's actually being used anywhere at this point, but there is certainly a lot of really interesting research going on, on this molecule.

• 1:05:02Speaker 03

  It is so cool. And I like, I can't wrap my, my head around how it would work the administration, how do you localize it, but...

• 1:05:10Speaker 00

  That's one of the big things. Like, what I saw the phase one trial was like a slow-inhaled product, which is really interesting. But I think that that's one of the big things. It's like, how exactly do we use this? Where are we targeting it? What are we targeting it for? And so I think there's still a lot of work to be done on like, how? How do we actually do that?

• 1:05:29Speaker 03

  Yeah. I mean, it is, it is really interesting to think about, like, there's more to the story than just poisonings.

• 1:05:36Speaker 00

  Isn't there always, Erin?

• 1:05:37Speaker 03

  There is.

• 1:05:37Speaker 00

  The dose makes the poison, etc.

• 1:05:39Speaker 03

  Yep, yep, yep.

• 1:05:42Speaker 00

  So if you'd like to learn more, there is a lot more there.

• 1:05:45Speaker 03

  There is, there is.

• 1:05:46Speaker 00

  We can tell you all of our sources.

• 1:05:48Speaker 03

  I have a bunch of sources. I'm going to shout out just a few. So if you want to learn more about just like general carbon monoxide history, there's a paper by Kashfi and Patel from 2022 called Carbon Monoxide and Its Role in Human Physiology: A Brief Historical Perspective. Then, if you want to learn about canaries and coal mines, there's a paper by Pollock from 2016 called The Canary in the Coal Mine, the Journal of Avian Medicine and Surgery. And then, if you, you really should, it's a fascinating paper on the haunted house from 1913 by Schneider, An Investigation of a Haunted House Published in Science. I'll post all of them on our website.

• 1:06:27Speaker 00

  Yeah. I, just a few papers, actually, for this, fewer than, than typical. But there was one from 1998 by Ernst and Zebak from the New England Journal of Medicine, just called Carbon Monoxide Poisoning. It's super straightforward, it tells you what you need to know. There was a more updated one that goes into a lot more detail on some of the effects other than just on hemoglobin, which was by Rose et al. from 2017, called Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions. And then I've got links to the World Health Organization Guidelines for Indoor Air Quality, the EPA and OSHA recommendations, and then two papers on the therapeutics use of carbon monoxide, one from Nature Reviews Drug Discovery from 2010, and then an updated one from just last

• 1:07:11Speaker 00

  year or the year before. You can find the list of sources from this episode and every single one of our episodes on our website, thispodcastwillkillyou.com.

• 1:07:20Speaker 03

  You certainly can. Big thank you to Blood Mobile for providing the music for this episode and all of our episodes.

• 1:07:27Speaker 00

  Thank you to Leanna, and Tom, and Mark, and Pete, and Jessica, and Christina, and everyone else at Exactly Right.

• 1:07:34Speaker 03

  Everyone, everyone.

• 1:07:35Speaker 00

  For all the work that you do to make this possible.

• 1:07:37Speaker 03

  Yes. And thank you to you, listeners, for also making this possible. Just the fact that you tune in is still incredible to us. So thank you, thank you.

• 1:07:45Speaker 00

  And that you tell your friends, and that you're watching on YouTube. Thank you so much. We love it. Thank you, as always, especially to our patrons for your support over on Patreon. It means more than we can say.

• 1:07:56Speaker 03

  Truly, truly. Well, until next time, wash your hands.

• 1:08:00Speaker 00

  You filthy animals.

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