A case of lung edema and methemoglobinemia after attempted suicide by charcoal burning

Abstract

The patient was a 24-year-old woman with a history of depression and panic disorder. She attempted
to commit suicide by burning charcoal in a sealed bathroom by placing charcoal on a steel mesh
grate and igniting it from the bottom using a barbecue stove. The bathroom was filled with white
smoke. After experiencing dyspnea, she opened the door of the bathroom and telephoned a friend
who called an ambulance. She was transported to a local hospital by the ambulance. On arrival, she
showed mild consciousness disturbance. A physiological examination revealed no specific findings.
Thoracic computed tomography showed a diffuse patchy ground glass appearance. The results of
an arterial blood gas analysis revealed carboxyhemoglobinemia and methemoglobinemia. She was
diagnosed with carbon monoxide poisoning, methemoglobinemia and chemical lung edema. She
was transferred to another hospital for hyperbaric oxygen therapy. After 5 days of hyperbaric oxygen
therapy, she was discharged without sequelae. This is the first case of carbon monoxide poisoning,
methemoglobinemia and lung edema without heart failure after an attempted suicide by charcoal
burning. The mechanism underlying the development of methemoglobinemia and lung edema is
discussed.