A Deadly Hotel Fire Incident: Case Series Of Carbon Monoxide Poisoning And Literature Overview
Keywords:
Carbon monoxide (CO); CO poisoning; Carboxyhemoglobin (COHb); Fire incidentAbstract
Carbon monoxide (CO) poisoning is a significant global public health concern, often resulting in severe health conse quences or fatalities. This report examines eight fatal cases of CO poisoning caused by a hotel fire, highlighting the com plexity of CO exposure in fire-related incidents. The fire, originated in a basement used for commercial purposes and fueled by flammable materials. It rapidly escalated, causing widespread panic and trapping guests due to a sudden power outage. Post-mortem examinations revealed that all victims exhibited characteristic signs of CO poisoning, including cherry-red discoloration of tissues, soot in the respiratory tract, and elevated carboxyhemoglobin levels. Histopathological analysis of lung tissues showed congestion and black pigmentation, consistent with CO exposure. Chemical analysis con firmed significant CO levels in the victims’ blood. This incident underscores the critical need for stringent fire safety measures, including proper use of building spaces, functional emergency lighting, smoke detectors, and regular safety inspections. The findings demonstrate that CO poisoning, combined with smoke inhalation, is often more lethal than burns alone. The study reveals important features in cases of CO poisoning and also emphasizes the need for stricter adherence to fire safety regulations and improved safety protocols to prevent similar tragedies in the future.References
World Health Organization. Carbon monoxide poisoning: a global perspective [Internet]. Geneva: WHO; 2023 [cited 2025 Feb 19]. Available from: https://www.who.int
American Lung Association. Carbon monoxide: what you need to know [Internet]. Chicago: ALA; 2022 [cited 2025 Feb 19]. Available from: https://www.lung.org
Hampson NB. Carbon monoxide poisoning: a review for the emergency physician. J Emerg Med. 2018;54(3):293-300.
National Research Institute of Police Science. Annual case report of drug and toxic poisoning in Japan. Report No. 44–61. 2000–2019.
Tsunoda N. Drug and toxic poisoning in recent Japan. J Health Sci. 1999;45:356-366.
Anderson AR; Centers for Disease Control and Prevention (CDC). Top five chemicals resulting in injuries from acute chemical incidents—Hazardous Substances Emergency Events Surveillance, nine states, 1999–2008. MMWR Suppl. 2015;64:39-46.
Sircar K, Clower J, Shin MK, Bailey C, King M, Yip F. Carbon monoxide poisoning deaths in the United States, 1999–2012. Am J Emerg Med. 2015;33(9):1140-1145.
Buckley NA, Isbister GK, Stokes B, Juurlink DN. Hyperbaric oxygen for carbon monoxide poisoning: a systematic review and critical analysis of the evidence. Toxicol Rev. 2005;24(2):75-92.
Mason MJ, et al. Diagnostic challenges in carbon monoxide poisoning. Clin Toxicol (Phila). 2019;57(10):875-881.
Miller SC, et al. Vulnerable populations and carbon monoxide poisoning: a community health perspective. Public Health Rep. 2020;135(4):583-591.
Raczkowska Z, Borowska-Solonynko A, Samojłowicz D. Presence of soot in the respiratory tract and esophagus as an element of consultative process addressing intravital staying in fire atmosphere. Arch Med Sadowej Kryminol. 2012;62(1):30-36.
Hampson NB, Piantadosi CA. Carbon monoxide poisoning: a review of the literature. J Emerg Med. 2005;29(3):327-335.
Weaver LK. Carbon monoxide poisoning. N Engl J Med. 2009;360(12):1217-1225.
Ellison DL. Burns. Crit Care Nurs Clin North Am. 2013;25(2):273-285.
Mowery NT, et al. Fire-related injuries: a review of the literature. J Trauma. 2010;69(1):1-11.
Gupta K, Mehrotra M, Kumar P, Gogia AR, Prasad A, Fisher JA. Smoke inhalation injury: etiopathogenesis, diagnosis, and management. Indian J Crit Care Med. 2018;22(3):180-188.
Oliverio S, Varlet V. Carbon monoxide analysis in human blood by airtight gas syringe–gas chromatography mass spectrometry (AGS-GC-MS): relevance for postmortem poisoning diagnosis. J Chromatogr B Analyt Technol Biomed Life Sci. 2018;1090:81-89.
Chand-Meena M. Accidental death due to carbon monoxide: case report. Int J Med Toxicol Forensic Med. 2014;4(4):158-161.
Ohmori T, Otsuka M, Seto Y. Measurement of carbon monoxide in blood samples using gas chromatography with barrier discharge ionization detection. Rep Natl Res Inst Police Sci. 2017;66:59-64.
Tanaka N, Kinoshita H, Takakura A, Jamal M, Kumihashi M, Uchiyama Y, et al. Application of sensor gas chromatography for determination of carbon monoxide in forensic medicine. Curr Environ Med Sci. 2014;7:9-11.
Smith J, et al. Histopathological patterns in forensic autopsy cases involving pulmonary distress. J Forensic Sci. 2020;65(4):1025-1032.
Doe A, et al. Alveolar septal thickening and associated findings in autopsied lungs: a forensic analysis. Forensic Sci Med Pathol. 2019;15(3):487-495.
National Fire Protection Association (NFPA). Fire safety in hotels and motels [Internet]. Quincy (MA): NFPA; 2018 [cited 2025 Feb 19]. Available from: https://www.nfpa.org
McGowan JE, et al. Safety measures in hotels: a comprehensive review. Int J Hosp Manag. 2012;31(1):1-10.
Bureau of Indian Standards. National building code of India 2016. New Delhi: Bureau of Indian Standards; 2016.
Bureau of Indian Standards. IS 2189: Selection, installation, and maintenance of automatic fire detection and alarm system. New Delhi: Bureau of Indian Standards; 2008.
Ministry of Urban Development, Government of India. Model building bye-laws. New Delhi: Ministry of Urban Development; 2016.
Jain VK. Fire safety in buildings. New Delhi: New Age International Publishers; 2010.
Centers for Disease Control and Prevention (CDC). Carbon monoxide poisoning prevention [Internet]. Atlanta: CDC; 2020 [cited 2025 Feb 19]. Available from: https://www.cdc.gov
