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February 24, 1989

The Twilight Zone: Death on a Sunday Morning

JAMA. 1989;261(8):1188. doi:10.1001/jama.1989.03420080108043

If it weren't for one peculiar twist of physical chemistry, carbon monoxide might be the least interesting of all the organic compounds. Its ubiquitous production results from the incomplete combustion of carbonaceous materials. More than 90% of atmospheric carbon monoxide is produced from automobile emissions, hundreds of millions of tons per year.1 While pollution alerts may indicate transient elevations in carbon monoxide, in the general environment, carbon monoxide levels are so low as to be clinically insignificant. The colorless, odorless, and tasteless gas is the most frequent cause of chemical asphyxiation. Although carbon monoxide itself is nonirritating and apparently nontoxic to cells, almost 50% of all deaths from poisoning are due to its inhalation.2 Carbon monoxide is lethal because of its occult nature and because at a normal pH, it has an affinity for hemoglobin 210 to 270 times greater than that of oxygen. When inhaled, most carbon