Carbon monoxide (CO) intoxication is one of the most common severe poisonings worldwide, affecting millions of people annually and leading to significant morbidity and mortality. [1] In addition to hypoxia, the main pathophysiological effect of CO poisoning is associated with direct cellular-level toxic effects, particularly liver damage. [2] Due to its metabolic activity and central role, the liver is highly sensitive to the toxic effects of CO, which is often not sufficiently considered in clinical practice. [3]
This article deeply examines the pathogenetic mechanisms of liver damage in CO intoxication and methods to correct them. Key pathogenetic aspects such as the direct cytotoxic effect of CO on liver cells, increased oxidative stress, mitochondrial dysfunction, activation of inflammatory reactions, and apoptotic pathways are studied. [4] The central role of mitochondria in CO-related liver damage is particularly emphasized, as it is considered the main cause of energy metabolism disruption and cell death. [5]
Oxidative stress arises from excessive production of reactive oxygen species (ROS) and deficiency in the antioxidant defense system, leading to lipid peroxidation, protein oxidation, and DNA damage, which cause structural and functional disruptions in liver cells. [6] Inflammatory processes develop in association with nuclear factor kappa B (NF-κB) and various cytokines (TNF-α, IL-1β, IL-6), leading to the expansion of liver damage and disruption of regeneration processes. [7]
Among the methods to correct pathogenesis, in addition to the traditional method of hyperbaric oxygen therapy (HBOT), new pharmacological approaches are discussed, including antioxidants (N-acetylcysteine, melatonin), anti-inflammatory agents, inhibitors of apoptotic pathways, and substances that restore mitochondrial function. [8] Data show that N-acetylcysteine not only exerts an antioxidant effect but also protects liver cells by restoring the glutathione system. [9] Melatonin, due to its strong antioxidant and anti-inflammatory properties, is considered effective in reducing liver damage in CO intoxication. [10]
This review article provides valuable information not only on the in-depth study of pathogenetic mechanisms but also on modern treatment strategies, which will help effectively manage the consequences of CO intoxication in clinical practice. [11] Early diagnosis of liver damage and the introduction of pathogenetically based therapy can significantly reduce complications and mortality rates after CO intoxication. [12].