Breaking the dry ice: A case of accidental carbon dioxide poisoning due to dry ice inhalation

Background: Solid dry ice undergoes sublimation to gaseous carbondioxide (CO2 ) at room temperature. Symptoms of exposure include headache, dizziness, unconsciousness, seizures, even coma and death based on concentrations of CO2 inhaled. We present a case of accidental poisoning due to dry ice inhalation. Case: 35-year-old Caucasian male with a history of depression and tobacco use was brought into the emergency department after he was found unconscious in the walk-in freezer at the fast-food center he was working at. On contacting his coworkers, we were told that the walk-in freezer was out of order, and they had packed it with dry ice. On examination, the patient was tachypneic, tachycardic and was saturating at 89% on room air. Physical examination was normal. Blood work showed acute hypoxic respiratory failure with metabolic acidosis with lactic acid 13.1 mmol/l. Carboxyhemoglobin level was elevated at 5.3% (normal level and smokers 3 to 5%). The patient significantly improved with supplemental oxygen and fluid boluses and was discharged in the next 24 hours. Conclusion: Exposure to dry ice in confined spaces and warm temperatures can lead to carbon dioxide poisoning. Accurate and detailed history taking helps recognize this potentially fatal medical emergency.