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C. S. Strande, MD
Dow Chemical USA Midland, Mich

JAMA. 1978;240(18):1955.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The letter in JAMA (239:2341, 1978) on carbon monoxide (CO) levels from methylene chloride exposure deserves a comment. While the conversion of methylene chloride to CO in vivo is well recognized, the mechanism, magnitude, and importance of this phenomenon are less well known. It is unfortunate, therefore, that potentially useful contributions to our knowledge in this area appear in the form of poorly documented accounts like the one presented in the aforementioned letter.

The correspondents conclude that the greatest threat to their patients was the continued high level of carboxyhemoglobin (COHb). In other words, their diagnosis in both cases is (acute) CO poisoning. In the range of 10% to 30% COHb, the expected clinical symptoms in order of decreasing incidence are as follows: headache, 94%; dizziness, 83%; hypertension, 63%; musculoskeletal weakness, 59%; and nausea, 31%.¹ Not one of these symptoms is described in either of their . . . [Full Text PDF of this Article]

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