Jornal de Toxicologia Clínica
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When is the Urine "Cherry Red" in Carbon Monoxide Poisoning?

Neil B. Hampson

For decades, physicians have been taught to look for “cherry red” coloration of the skin and mucous membranes in patients with carbon monoxide (CO) poisoning, but this is rarely seen [1,2]. In 1857, Hoppe in Germany first described the change in blood color when hemoglobin is loaded with CO [3]. Because carboxyhemglobin (COHb) is a brighter shade of red than oxyhemglobin and the color of capillary blood contributes to skin color, it would seem reasonable that a poisoned patient’s appearance might change with sufficient amounts of circulating COHb. However, a lethal level of COHb is required for a human’s skin and mucous membranes to appear “cherry red”. Even when reflectance spectrometry is used to measure skin color after death in individuals who have died of CO poisoning, less than one-half demonstrate “cherry red” skin [4]. Recently, however, “cherry red” urine has been described in a subgroup of individuals with acute CO poisoning [5].