Asphyxiants
(Irrespirable gases)
Introduction
• Asphyxiants mainly produce respiratory embarrassment.
• The important asphyxiants are Carbon Monoxide, Carbon Dioxide, Hydrogen
Sulphide and some war gases.
• Carbon Monoxide reduces the Oxygen carrying capacity of the blood.
• Carbon dioxide produces oxygen lack in the tissues.
• Hydrogen Sulphide paralyses the respiratory centre.
Carbon Monoxide
• It is a colourless, odourless, non irritant gas which cannot be perceived by the
senses.
• It is formed by incomplete combustion of carbon and organic matter.
• The affinity of carbon monoxide for Hb is about 200-300 times greater than
that of oxygen.
• It displaces oxygen and combines with Hb to form carboxyhaemoglobin
which results in tissue anoxia.
Symptoms of saturation of CO in blood
Saturation of Hb Symptoms
with CO
0-10% No appreciable symptoms
10-20% Shortness of breath on exertion, mild headache, lassitude and flushed skin
20-30% Throbbing headache, buzzing in the ears. Breathlessness, muscular weakness and
incoordination, dulling of senses.
30-40% Severe headache, dizziness, nausea, vomiting, collapse on slight exertion. Breathlessness.
Mental confusion, impaired judgement, muscular weakness and incoordination. Dim
vision.
40-50% All symptoms intensified. May be mistaken with drunkenness. Incoordination, staggering,
mental confusion, loss of memory, palpitation and dyspnea.
50-70% Intermittent asphyxial convulsions, coma, Cheyne Stokes respiration, respiratory paralysis
and death.
Above 70% Rapidly fatal due to respiratory arrest.
Fatal dose and fatal period
• At rest, 0.1% of CO will result in stupor and coma in 2.5 to 3 hours, but with
exercise an hour will suffice.
• 1% concentration will result in coma in 15 to 20 minutes.
Treatment
• Patient must be removed to fresh air and body warmth maintained and if patient is
conscious no further treatment is necessary.
• Artificial respiration is needed if breathing is irregular.
• Antibiotics against lung infection.
Postmortem appearances
• Fine froth at mouth and nose.
• Colour of skin is bright cherry red.
• Internally, viscera, blood and tissues are of bright cherry red colour, if there is
more than 5gm COHb/100 ml of blood.
• Brain may be edematous and petechial haemorrhages may be seen.
• Lungs may be edematous or show bronchopneumonia.
• COHb is stable and can be detected in highly putrefied bodies .
Lab tests to confirm COHb
• In case of suspected CO poisoning, a layer of 1-2 cm of liquid paraffin should be
added immediately over the collected blood sample to avoid exposure to air.
• A sample of suspected blood is diluted with 4 times its volume of water and a few
drops of 3%aqueous tannic acid solution is added to it. It is then shaken. If more
than 10% CO is present, it forms a pinish white precipitate.
• A sample of suspected blood is diluted 20 times its volume with water and 10
drops of 10% caustic soda is added to it. Normal blood becomes greenish brown
due to methaemoglobin but blood containing more than 10% CO retains its bright
red colour.
Medicolegal aspects
• Suicide.
• Accidental.
