Analysis of patients presenting to the emergency department with carbon monoxide intoxication

Abstract

ObjectivesCarbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT) is of proven efficacy in the treatment of CO intoxication.The purpose of this study was to describe the general characteristics of carbon monoxide (CO) intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT) in these patients.Material and methodsPatients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively.ResultsOne hundred seventy-one patients were included; 140 (81.9%) were poisoned by stoves, 18 (10.5%) by hot water boilers and 10 in (5.8%) by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5%) of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%). One patient died after 15 session of HBOT.ConclusionAlthough elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT.

Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

“…Due to these findings such patients underwent HBOT treatment. 14,15 There were no statistically significant differences in COHb levels between smoker and non-smokers in this series.…”

“…13 As such, persistence of symptoms despite NBOT is one of the main indications for the use of HBOT. 13,14,15 Intense wild and urban fires swept the metropolitan area of Funchal in Madeira Island, Portugal, starting in August 8 th 2016 under the triad of extreme heat (mean temperatures of 29.5º Celsius), low humidity and strong winds. This was an almost unprecedented set of environmental conditions for this subtropical Atlantic island that lasted five days.…”

“…5 A rise in troponin was also observed, as elsewhere reported and agrees with cardiac muscle injury through CO mediated pathways involving mitochondrial dysfunction and free radical generation. 5,15 This case series includes other particular aspects such as inclusion of children and pregnant women. Both groups were assessed by paediatricians and obstetricians, respectively, prior to HBOT delivery.…”

Carbon Monoxide Poisoning In Children: Which Cases Should Receive Advanced Cardiologic Evaluation?

“…Carbon monoxide poisoning can be seen for different reasons depending on the region and sociocultural factors. (13) Some studies have reported stove poisoning as the most common source of poisoning, (8,(13)(14)(15) and some as natural gas poisoning (16)(17)(18). In the last 20 years, the use of natural gas as a fuel has become widespread in Ankara.…”

A retrospective observational study on patients intoxicated by drugs and other xenobiotics

“…Gases constituted the third cause of poisoning, with carbon monoxide as the most potentially fatal form. Accidentrelated intoxication is common in winter, connected with the use of gas heating, but throughout the year there are cases of suicide attempts involving carbon monoxide [33].…”