The "oxygen saturation gap" is the difference between the calculated oxygen saturation from a standard blood gas machine and the reading from a pulse oximeter. If it is greater than 5%, the patient's hemoglobin may be abnormal, representing carbon monoxide poisoning, methemoglobinemia, or sulfhemoglobinemia. We report a case,where awareness of the saturation gap led to the diagnosis of carbon monoxide poisoning. (C) 2007 Elsevier Inc.