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KMID : 0376219780150010113
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Chonnam Medical Journal
1978 Volume.15 No. 1 p.113 ~ p.122
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Studies on the Treatment of Carbon Monoxide Poisoning
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Abstract
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In an attempt to provide an aid in the treatment of CO poisoning by promoting the dissociation of carboxyhemoglobin(CO-Hb), the in vitro and in vivo effects on the CO-Hb dissociation of the agents which reduce the hemoglobinoxygen affinity were investigated. The agents employed were the mixture of inosine, pyruvate, and phosphate(IPP) which stimulate the synthesis of the intraerythrocytic 2,3-diphosphoglycerate(2,3-DPG), and sodium o iodobenzoate (OISB) which is reportedly capable of rapid passage into the red cell interior for direct but reversible interaction with hemoglobin without any demonstrable ill effects on the erythrocyte morphology and metabolism.
Human blood stored for 5 days was pre-incubated at 37° for 2 hours with the. mixture of 10 mM inosine,. 5 mM sodium pyruvate and 5 mM Na2HP04. This IPP treatment caused a more than 10-fold increase in the concentration of 2,3DPG from lowered level during blood storage to the normal one. After the blood was treated with CO, the CO-Hb dissociation was determined during incubation . at 37´ for 4 hours. The IPP-treated group showed a more rapid dissociation of CO-Hb than the untreated control group. However, in fresh human blood with the normal level of 2, 3-DPG, the IPP treatment caused only a 6 % increase in the 2, 3=DPG level, and the CO-Hb dissociation was not enhanced further than the control group. To examine the in vivo effect of IPP treatment, the IPP mixture (0. 1 M each of inosine, pyruvate, and phosphate) was given intraperitoneally to 5 mice at a dose of 20 s€/kg 3 hours before CO poisoning. As soon as the IPP-treated, and-saline -control-mice were -collapsed by CO,- they were. placed in´-open fresh air to recover from CO intoxication. It, was found that there were . no significant ;differences ;in the recovering time and . their behavior between. ´both groups. y
In a few cases where the rates of the CO-Hb dissociation. were determined, by incubating -at 37° the CO-treated rabbit blood, and shaking in a shaker. _bath, 5 mM OISB was found to exert a little enhancing effect on the CO-Hb dissociation. However, when as many as 18 CO-treated blood samples were examined by an equilibrium method, i. e. , by incubating the blood at 37° for 8 hours in a sealed vessel of volume 100 times the blood volume to make CO equilibrate between the blood and gas phase, OISB was found to be without effect on the CO-Hb dissociation. For in vivo experiment, the isotonic OISB solution was given intraperitoneally to 6 mice at a dose of 350 mg/kg 2 days before CO poisoning, and the rate of CO-Hb dissociation was determined during recovery period. The in vivo dissociation of, CO-Hb, while occurring logarithmically against time, was not affected significantly by the OISB pretreatment.
These results indicate that the effective treatment for acute CO poisoning by manipulating the dissociation of CO-Hb is not possible with the agents known to reduce the hemoglobin-oxygen affinity. However, it is suggested that if the intraerythrocytic 2,3: DPG level is lower than the normal one, the L P administration would be beneficial for the recovery from CO poisoning.
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