Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning?

2014 ◽  
Vol 34 (3) ◽  
pp. 324-329 ◽  
Author(s):  
NÖ Doğan ◽  
A Savrun ◽  
S Levent ◽  
GP Günaydın ◽  
GK Çelik ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Lactate Level ◽  
Carbon Monoxide Poisoning ◽  
Co Poisoning ◽  
Cross Sectional ◽  
Normobaric Oxygen ◽  
Clinical Criteria ◽  
Oxygen Treatment ◽  
Co Intoxication ◽  
Lactate Levels

Introduction: Accidental carbon monoxide (CO) intoxication is a major cause of unintentional poisoning. This study aimed to determine the value of initial lactate levels in patients with CO poisoning and to evaluate its utilization in the emergency department (ED). Methods: A retrospective cross-sectional study was carried out among patients with CO intoxication, who were admitted to the ED between April 1, 2011 and April 1, 2012. The study data were extracted from a hospital database system using International Classification of Diseases-10 diagnosis codes. The patients were analyzed according to lactate levels, carboxyhemoglobin (COHb) levels, electrocardiographic manifestations, and clinical features at admission to the ED. Results: A total of 74 patients with CO poisoning were enrolled in this study. The average COHb value of the patients was 21.5 ± 13.9%. A total of 50 patients (67.6%) received normobaric oxygen treatment and 24 patients (32.4%) received hyperbaric oxygen (HBO) treatment. The patients who received HBO treatment had increased lactate levels compared with patients receiving normobaric oxygen treatment (2.3 mmol/L vs. 1.0 mmol/L, p < 0.001). The lactate levels were positively correlated with COHb values ( r = 0.738, p < 0.001). We determined that a lactate level of 1.85 mmol/L has a sensitivity of 70.8% and a specificity of 78.0% to predict the HBO treatment needed in CO poisoning. Conclusion: In evaluating patients with CO poisoning, an initial lactate level could be taken into consideration as an adjunctive parameter of severity, together with the clinical criteria and levels of COHb.

scholarly journals An Analysis of Patients With Carbon Monoxide Poisoning Transported by a Physician-Staffed Helicopter

2019 ◽  
pp. 43-47
Author(s):  
iroki Nagasawa ◽  
Youichi Yanagawa
Keyword(s):  
Carbon Monoxide ◽  
Study Design ◽  
Carbon Monoxide Poisoning ◽  
Male Gender ◽  
Co Poisoning ◽  
Middle Aged ◽  
Normobaric Oxygen ◽  
Base Hospital ◽  
Oxygen Treatment ◽  
Before And After

OBJECTIVE: We retrospectively investigated a series of patients with carbon monoxide (CO) poisoning transported by a physician-staffed helicopter (DH) to seek evidence supporting the daily management of patients with CO poisoning. STUDY DESIGN: Subjects were divided into two groups: the carboxyhemoglobin saturation (SpCO) (+) group, which included patients who had a pulse CO-oximeter attached during transportation; and the SpCO (-) group, which included all other patients. We compared the level of SpCO before and after transportation when the level was noted. RESULTS: The subjects were predominantly middle-aged and male. Seventeen subjects (53.1%) received a diagnosis of CO poisoning based on the situation in which the subjects were found, without the carboxyhemoglobin level being measured. No subjects show deterioration of their condition after transportation, and none ultimately died. The frequency of male gender, normobaric oxygen treatment and return to the base hospital in the SpCO (+) group was significantly greater than in the SpCO (-) group. The SpCO levels after transportation were significantly lower than they had been before transportation. CONCLUSION: This is the first study to show the results of the analysis of patients with CO poisoning transported by the DH. All patients with CO poisoning were safely transported.

scholarly journals Hyperbaric Oxygen Treatment for Carbon Monoxide Poisoning in Italy: Retrospective Validation of a Data Collection Tool for the Italian Registry of Carbon Monoxide Poisonings (IRCOP)

2020 ◽  
Vol 17 (2) ◽  
pp. 574
Author(s):  
Lidio Maffi ◽  
Matteo Paganini ◽  
Giuliano Vezzani ◽  
Antonios Soumelis ◽  
Enrico M Camporesi ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Data Collection ◽  
Hyperbaric Oxygen ◽  
Carbon Monoxide Poisoning ◽  
The Body ◽  
Co Poisoning ◽  
Data Collection Tool ◽  
Hyperbaric Oxygen Treatment ◽  
Oxygen Treatment ◽  
Co Intoxication

Background: Carbon Monoxide (CO) poisoning is a frequent cause of intoxication. However, CO poisoning incidence is globally underreported, as well as its features, especially in Italy. The aim of this study was to investigate such characteristics of CO intoxication and foster the creation of the Italian Registry of Carbon Monoxide Poisonings. Methods: A data collection tool was developed and organized in five sections: Patient’s characteristics; CO intoxication modality; emergency medical service and emergency department; hyperbaric facility; outcomes. The tool was validated through a retrospective analysis, including CO intoxicated patients treated in 14 Italian hyperbaric facilities between 2015 and 2016. Results: A total of 1383 patients were included. The high completion ratio (85%) of the collection tool suggests its feasibility in practical terms. CO intoxications were mostly accidental (93.64%) and caused by solid fuel (48.59%). There was not a uniform application of hyperbaric oxygen treatment protocols, but most of the patients were adequately treated at least at 2.5 ATA for more than 60 min (44.97%). Conclusion: This analysis provided new information that was previously unavailable in this country. Furthermore, this tool proved to be a valid base for future registry aiming to consolidate the body of knowledge about CO intoxications in Italy.

scholarly journals Temporal trends of carbon monoxide poisoning mortality at the global, regional and national levels: a cross-sectional study from the Global Burden of Disease study, 1990 and 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053240
Author(s):  
Jianhai Long ◽  
Yawei Sun ◽  
Junxiu Zhao ◽  
Jie Liu ◽  
Xiaobo Peng
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
National Level ◽  
Temporal Trends ◽  
Global Burden ◽  
Co Poisoning ◽  
Cross Sectional Survey ◽  
Mortality Trends ◽  
Fatal Poisoning ◽  
Cross Sectional

ObjectivesCarbon monoxide (CO) poisoning is one of the most frequent causes of fatal poisoning worldwide. Few studies have explored the mortality trends of CO poisoning grouped by age and gender, at the regional, national and global levels. We therefore aimed to determine the pattern of CO poisoning mortality, as well as temporal trends at all levels.DesignA cross-sectional survey design was used in this study.SettingCO poisoning data collected from the Global Burden of Diseases (GBDs), from 1990 to 2017, was arranged by sex, age, region and country. In addition, we used human development index data at the national level from the World Bank.ParticipantsWe collected over 100 000 information on CO poisoning mortality between 1990 and 2017, derived from the GBD study in 2017.Main outcomes and measuresWe have calculated the estimated annual percentage changes in CO poisoning age-standardised mortality rate (ASR), by sex and age at different regions and countries to quantify the temporal trends in CO poisoning ASR.ResultsGlobally, death cases of CO poisoning decreased 7.2% from 38 210 in 1990 to 35 480 in 2017. The overall ASR decreased by an average of 1.83% (95% CI 2.10% to 1.56%) per year in this period. This decreasing pattern was heterogeneous across ages, regions and countries. The most pronounced decreases were generally observed in countries with a high sociodemographic index, including Estonia, South Korea and Puerto Rico.ConclusionsCurrent prevention strategies should be reoriented, and much more targeted and specific strategies should be established in some countries to forestall CO poisoning.

The relationship among plasma copeptin, carboxyhemoglobin, and lactate levels in carbon monoxide poisoning

2019 ◽  
Vol 39 (3) ◽  
pp. 311-318
Author(s):  
S Ozkan ◽  
O Salt ◽  
P Durukan ◽  
A Sen ◽  
E Bulbul ◽  
...  
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Plasma Levels ◽  
Carbon Monoxide Poisoning ◽  
Serum Lactate ◽  
Co Poisoning ◽  
Stress Hormone ◽  
Significant Difference ◽  
Lactate Levels ◽  
The Relationship

Objective: The aim of our study is to determine whether there is a change in the plasma levels of copeptin and there is a relationship among the plasma levels of carboxyhemoglobin (COHb), lactate, and copeptin levels in patients presenting to the emergency department with carbon monoxide (CO) poisoning. Methods: Fifty-seven patients admitted to the emergency department with CO poisoning were included in the study. The blood samples of the patients were collected on arrival 0th, 6th, and 12th hours for copeptin, lactate, and COHb levels. Data were analyzed using SPSS-17 statistical software. Results: Arrival serum copeptin levels of the patients were compared to copeptin levels of healthy individuals and a statistically significant difference was found between them ( p = 0.008). There was a statistically significant difference between the arrival levels of copeptin and 6th-hour ( p = 0.006) and 12th-hour ( p = 0.001) levels of copeptin. There was no significant difference between 6th-hour and 12th-hour copeptin levels ( p = 0.51). In terms of serum lactate levels, there was a significant difference between arrival and 6th h ( p < 0.001), arrival and 12th h ( p < 0.001), and 6th and 12th h ( p < 0.001). Likewise, in terms of serum COHb levels, there was a significant difference between arrival and 6th h ( p < 0.001), arrival and 12th h ( p < 0.001), and 6th and 12th h ( p < 0.001). There was a positive correlation between COHb and lactate levels on arrival ( r = 0.52; p = 0.001). Conclusion: Copeptin as a stress hormone can be used in the diagnosis and monitoring of patients with CO poisoning. However, the copeptin level was not superior to COHb and lactate levels.

Determination of netrin-1 levels and its relationship with neurotoxicity in carbon monoxide poisoning

2019 ◽  
Vol 38 (5) ◽  
pp. 561-566 ◽  
Author(s):  
U Gedikli ◽  
E Emektar ◽  
SK Corbacioglu ◽  
S Dagar ◽  
H Uzunosmanoglu ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Patient Group ◽  
Carbon Monoxide Poisoning ◽  
Neurological Impairment ◽  
Neurological Involvement ◽  
Control Group ◽  
Co Poisoning ◽  
Cross Sectional ◽  
Significant Difference ◽  
Neurological Effects

Objective: The aim of the study was to assess netrin-1 levels in carbon monoxide (CO) poisoning to determine its relationship with poisoning severity and neurotoxicity. Methods: This is a cross-sectional prospective study. The patients older than 18 years with CO poisoning were included. The patients were categorized into two groups on the basis of neurological involvement. Both the patient and the control groups were sampled for netrin-1 at 0th hour, and the patient group only was sampled for netrin-1 at 4th hour. Results: A total of 84 patients and 50 healthy controls were enrolled. The median 0th hour netrin-1 level of the patient group (765.1 pg/mL (619.8-983.1) was significantly higher than the control group (484 pg/mL (376-1031.6)) ( p < 0.001). There was also a significant difference between the 0th hour and 4th hour netrin-1 (888.9 pg/mL (700.3–1175.5)) levels in the patient group ( p < 0.001).There was no significant statistical difference between patients with and without neurological involvement ( p = 0.62) and between those who underwent hyperbaric oxygen therapy (HBOT) and those who did not ( p = 0.76) with respect to 4th hour netrin-1 levels. Conclusion: The significantly higher netrin-1 levels in patients with CO poisoning, suggests that netrin-1 is elevated as a stress marker. Although there is no significant difference in netrin-1 levels in patients with neurological impairment in CO poisonings, netrin-1 may show subclinically neurological effects. Hence, we believe that netrin-1 cannot be used as a marker of poisoning severity.

Carbon monoxide poisoning cases presenting with non-specific symptoms

2016 ◽  
Vol 33 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Turgut Deniz ◽  
Hayati Kandis ◽  
Oguz Eroglu ◽  
Harun Gunes ◽  
Meral Saygun ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Cross Sectional Study ◽  
Motor Vehicles ◽  
Co Poisoning ◽  
Cross Sectional ◽  
Heating Systems ◽  
Presenting Symptoms ◽  
Non Invasive ◽  
Specific Symptoms

Carbon monoxide (CO) is a colourless and odourless gas appearing as a result of incomplete combustion of carbon-containing fuels. Many domestic or occupational poisonings are caused by CO exposure. Malfunctioning heating systems, improperly ventilated motor vehicles, generators, grills, stoves and residential fires may be listed in the common sources of CO exposure. The aim of this study was to emphasize the significance of early diagnosis of CO poisoning with non-invasive measurement of CO levels of the patients with non-specific symptoms using a pulse oximeter device in the triage. Our study was a cross-sectional study. Patients who presented to the emergency department (ED) due to non-specific symptoms and had a Canadian Triage and Acuity scale level of 4 or 5 were included in the study; 106 (5.9%) of 1788 patients admitted during the study period were diagnosed with CO poisoning. Patients with CO poisoning and the other patients had statistically significant differences in terms of presenting symptoms, namely, headache, dizziness, nausea, and vomiting. More CO poisoning cases were admitted in the fall and winter compared to the spring and summer. The number of CO poisoning victims can be decreased if preventive measures like CO monitoring systems and well-designed ventilation systems are generalized at homes and workplaces. Measurement of carboxyhaemoglobin levels of patients presenting to ED due to non-specific symptoms like headache and dizziness during cold seasons and winter months using a pulse CO-oximeter should be a part of the routine of emergency medicine triage.

scholarly journals Extracorporeal Hyperoxygenation Therapy (EHT) for Carbon Monoxide Poisoning: In-Vitro Proof of Principle

Membranes ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 56
Author(s):  
Niklas B. Steuer ◽  
Peter C. Schlanstein ◽  
Anke Hannig ◽  
Stephan Sibirtsev ◽  
Andreas Jupke ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Hollow Fibre ◽  
Co Poisoning ◽  
Normobaric Oxygen ◽  
Elevated Pressures ◽  
Bubble Oxygenator ◽  
Novel Method ◽  
The Difference

Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths globally. The currently available therapy options are normobaric oxygen (NBO) and hyperbaric oxygen (HBO). While NBO lacks in efficacy, HBO is not available in all areas and countries. We present a novel method, extracorporeal hyperoxygenation therapy (EHT), for the treatment of CO poisoning that eliminates the CO by treating blood extracorporeally at elevated oxygen partial pressure. In this study, we proof the principle of the method in vitro using procine blood: Firstly, we investigated the difference in the CO elimination of a hollow fibre membrane oxygenator and a specifically designed batch oxygenator based on the bubble oxygenator principle at elevated pressures (1, 3 bar). Secondly, the batch oxygenator was redesigned and tested for a broader range of pressures (1, 3, 5, 7 bar) and temperatures (23, 30, 37 °C). So far, the shortest measured carboxyhemoglobin half-life in the blood was 21.32 min. In conclusion, EHT has the potential to provide an easily available and effective method for the treatment of CO poisoning.

Verbal memory deficits associated with fornix atrophy in carbon monoxide poisoning

2001 ◽  
Vol 7 (5) ◽  
pp. 640-646 ◽  
Author(s):  
SHELLI R. KESLER ◽  
RAMONA O. HOPKINS ◽  
LINDELL K. WEAVER ◽  
DUANE D. BLATTER ◽  
HOLLY EDGE-BOOTH ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Verbal Memory ◽  
Visual Memory ◽  
Carbon Monoxide Poisoning ◽  
Neuropsychological Testing ◽  
Mr Images ◽  
Cross Sectional ◽  
Memory Processing ◽  
Within Subjects ◽  
And Gender

Magnetic resonance (MR) images and neuropsychological testing data of 69 carbon monoxide (CO) poisoned patients were prospectively obtained within 1 day of CO poisoning, two weeks and six months. CO patients' Day 1 cross-sectional fornix surface area measurements, corrected for head size by using a fornix-to-brain ratio (FBR), were compared to normal age and gender-matched controls. Additionally, a within-subjects analysis was performed comparing the mean areas between CO patients' Day 1, 2 weeks and 6-month FBR. The FBR was correlated with patients' neuropsychological data. There were no significant differences between CO patients' Day 1 fornix measurements compared to normal control subjects. However, significant atrophic changes in the fornix of CO poisoned patients occurred at two weeks with no progressive atrophy at 6 months. By 6 months, CO patients showed significant decline on tests of verbal memory (when practice effects were taken into account), whereas visual memory, processing speed and attention/concentration did not decline. This study indicates that CO results in brain damage and cognitive impairments in the absence of lesions and other neuroanatomic markers. (JINS, 2001, 7, 640–646.)

scholarly journals Predictive Role of QTc Prolongation in Carbon Monoxide Poisoning-Related Delayed Neuropsychiatric Sequelae

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Shu-Chen Liao ◽  
Yan-Chiao Mao ◽  
Yao-Min Hung ◽  
Ching-Hsing Lee ◽  
Chen-Chang Yang
Keyword(s):  
Carbon Monoxide ◽  
Roc Curve ◽  
Carbon Monoxide Poisoning ◽  
Chang Gung Memorial Hospital ◽  
Qtc Interval ◽  
Continuous Variables ◽  
Co Poisoning ◽  
Qtc Prolongation ◽  
Roc Curve Analysis ◽  
Delayed Neuropsychiatric Sequelae

Objective. Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients’ quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. Methods. This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. Results. A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21–6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31–9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03–1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21–5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660–0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. Conclusions. We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning.

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