 Another mechanism involves effects on the mitochondrial respiratory enzyme chain that is responsible for effective tissue utilization of oxygen . Carbon monoxide binds to cytochrome oxidase with less affinity than oxygen , so it is possible that it requires significant intracellular hypoxia before binding . This binding interferes with aerobic metabolism and efficient adenosine triphosphate synthesis . Cells respond by switching to anaerobic metabolism , causing anoxia , lactic acidosis , and eventual cell death . The rate of dissociation between carbon monoxide and cytochrome oxidase is slow , causing a relatively prolonged impairment of oxidative metabolism . 
