Which treatment is commonly ordered for inhaled poisons such as carbon monoxide?

• A. Activated charcoal
• B. No treatment
• C. IV fluids only
• D. Supplemental oxygen

Answer: (D)

Inhaled poisons like carbon monoxide disrupt oxygen delivery by binding strongly to hemoglobin, forming carboxyhemoglobin and preventing oxygen from binding where it’s needed. The treatment that best addresses this is giving very high levels of oxygen to both displace the carbon monoxide from hemoglobin and increase the amount of oxygen carried to tissues. Supplying 100% oxygen accelerates CO elimination from the blood, shortening the toxin’s effective duration and reducing tissue hypoxia. In severe cases, hyperbaric oxygen can be used to further speed up clearance and protect the brain and other organs.

Activated charcoal isn’t helpful for inhaled poisons because it acts in the gut to bind toxins there, not in the lungs or bloodstream. IV fluids alone don’t remove the toxin from the blood, though they can support overall circulation. So the most appropriate common treatment is supplemental oxygen to rapidly restore oxygen delivery.