Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study

Handan Ayhan Akoğlu; Muhammet Bulut; Gökhan Tonkaz; Hilmi Furkan Arslan; Emine Tekin; Bekir Yükcü

Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study

Abstract

Aims: To evaluate the association between fractional carboxyhemoglobin (FCOHb) levels and biochemical markers of poisoning severity, and to describe cardiac and neuroimaging findings in a pediatric cohort affected by a single-source mass carbon monoxide (CO) exposure. Methods: This retrospective cross-sectional study included pediatric patients exposed during a single-source mass CO exposure event. Of 64 screened patients, 6 were excluded from inferential analyses because their initial FCOHb levels were <5%, leaving 58 patients in the analytical cohort. All blood gas analyses were venous. Age- and sex-adjusted multiple linear regression was used to examine associations between FCOHb and biochemical parameters. Cardiac and neuroimaging findings were evaluated descriptively in clinically selected subgroups. Results: Higher FCOHb levels were associated with increased lactate (B=0.089, p=0.001) and lactate dehydrogenase (B=3.631; p=0.005), and decreased bicarbonate (B=-0.096; p=0.005), venous pO2 (B=-0.701; p=0.044) and base excess (B=-0.112; p=0.026). No significant age- and sex-adjusted association was found between FCOHb and cardiac troponin-I (cTnI) (p=0.433). cTnI elevation was observed in 17 patients (29.3%); however, echocardiography in the selected subgroup showed no major acute systolic dysfunction. In the MRI-evaluated subgroup, no CO-specific central nervous system injury pattern was identified; findings consisted predominantly of nonspecific sinonasal and mastoid mucosal changes. Conclusion: FCOHb was associated with biochemical indicators of tissue hypoxia and metabolic disturbance, but did not reliably reflect cardiac involvement. Cardiac and neuroimaging findings should be interpreted within the selected subgroups.

Keywords

Supporting Institution

None

Project Number

None

Ethical Statement

Ethical approval for this study was obtained from the Giresun Training and Research Hospital Scientific Research Ethics Committee (Decision Date: 30.04.2025, Decision No: 14). All procedures were performed in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.

Thanks

The authors would like to express their sincere gratitude to the duty physicians, nursing staff, and emergency department personnel who were on service during the carbon monoxide exposure event for their dedicated efforts and contributions to the initial medical stabilization and data collection process of the patients.

References

Chenoweth JA, Albertson TE, Greer MR. Carbon monoxide poisoning. Crit Care Clin. 2021;37(3):657-672. doi:10.1016/j.ccc.2021.03.010
Nañagas KA, Penfound SJ, Kao LW. Carbon monoxide toxicity. Emerg Med Clin North Am. 2022;40(2):283-312. doi:10.1016/j.emc.2022.01.005
Sethuraman KN, Douglas TM, Bostick BB, Comer AC, Myers B, Rosenthal RE. Clinical characteristics of pediatric patients with carbon monoxide poisoning. Pediatr Emerg Care. 2020;36(4):178-181. doi:10.1097/PEC.0000000000001378
Güven D, Sarıcı D. Clinical and laboratory characteristics predicting the severity of carbon monoxide poisoning in children: a single-center retrospective study. Pediatr Emerg Care. 2023;39(4):207-215. doi:10.1097/PEC.0000000000002927
Aykut A, Günsoy E, Karabulut BÖ, Aktaş RS, Öncül MV, Karabulut AE. Serum lactate and carboxyhemoglobin as predictors of hyperbaric oxygen therapy in carbon monoxide poisoning: a retrospective study. BMC Emerg Med. 2025;25(1):252. doi:10.1186/s12873-025-01410-w
İpek S, Güllü UU, Güngör Ş, Demiray Ş. The effect of full blood count and cardiac biomarkers on prognosis in carbon monoxide poisoning in children. Ir J Med Sci. 2023;192(5):2457-2466. doi:10.1007/s11845-022-03232-2
Hampson NB. Carboxyhemoglobin: a primer for clinicians. Undersea Hyperb Med. 2018;45(2):165-171.
Rose JJ, Wang L, Xu Q, et al. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Respir Crit Care Med. 2017;195(5):596-606. doi:10.1164/rccm.201606-1275CI

Vural A, Dolanbay T, Ozcelik M, et al. Biochemical parameters and clinical outcomes of carbon monoxide poisoning in special groups: children, pregnant women, and the elderly. Eur Rev Med Pharmacol Sci. 2024;28(11):3711-3724. doi:10.26355/eurrev_202406_36376
Damlapinar R, Arikan FI, Sahin S, Dallar Y. Lactate level is more significant than carboxihemoglobin level in determining prognosis of carbon monoxide intoxication of childhood. Pediatr Emerg Care. 2016; 32(6):377-383. doi:10.1097/PEC.0000000000000452
Bagci Z, Arslan A, Arslan D. The value of neutrophil:lymphocyte ratio and platelet:lymphocyte ratio in predicting clinical severity in children with carbon monoxide poisoning. Indian J Pediatr. 2021;88(11):1121-1126. doi:10.1007/s12098-021-03704-w
Memiş S, Demirtaş MS, Erdal H, et al. Systemic inflammatory markers (NLR/PLR) and climatic factors as predictors of severity in pediatric carbon monoxide poisoning. Med Records. 2025;7(3):756-762. doi:10.37990/medr.1726333
Kaçer EÖ. The prognostic value of Systemic Immune-inflammation Index in children with carbon monoxide poisoning. J Contemp Med. 2023;13(5):879-884. doi:10.16899/jcm.1347034
Acar T, Ertekin B. The role of SII and SIRI values in predicting the severity of CO poisoning in the emergency department. Phnx Med J. 2023;5(1):23-31. doi:10.38175/phnx.1224860
Akcan Yildiz L, Gultekingil A, Kesici S, Bayrakci B, Teksam O. Predictors of severe clinical course in children with carbon monoxide poisoning. Pediatr Emerg Care. 2021;37(6):308-311. doi:10.1097/PEC.0000000000001580
Cho CH, Chiu NC, Ho CS, Peng CC. Carbon monoxide poisoning in children. Pediatr Neonatol. 2008;49(4):121-125. doi:10.1016/S1875-9572(08)60026-1
Afzal M, Agarwal S, Elshaikh RH, et al. Carbon monoxide poisoning: diagnosis, prognostic factors, treatment strategies, and future perspectives. Diagnostics (Basel). 2025;15(5):581. doi:10.3390/diagnostics15050581
Kang G, Zhang H. Concerning “predictors of severe clinical course in children with carbon monoxide poisoning.” Pediatr Emerg Care. 2021; 37(12):e1762. doi:10.1097/PEC.0000000000001905
Cho DH, Thom SR, Son JW, Ko SM, Cha YS. Practical recommendations for the evaluation and management of cardiac injury due to carbon monoxide poisoning. JACC Heart Fail. 2024;12(8):1343-1352. doi:10.1016/j.jchf.2024.01.001
Kalay N, Ozdogru I, Cetinkaya Y, et al. Cardiovascular effects of carbon monoxide poisoning. Am J Cardiol. 2007;99(3):322-324. doi:10.1016/j.amjcard.2006.08.030
Hancı V, Ayoğlu H, Yurtlu S, et al. Effects of acute carbon monoxide poisoning on the P-wave and QT interval dispersions. Anadolu Kardiyol Derg. 2011;11(1):48-52. doi:10.5152/akd.2011.009
Li W, Meng J, Lei J, Li C, Yue W. Carbon monoxide poisoning with hippocampi lesions on MRI: cases report and literature review. BMC Neurol. 2024;24(1):159. doi:10.1186/s12883-024-03668-2
El-Sarnagawy GN, Elgazzar FM, Ghonem MM. Development of a risk prediction nomogram for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Inhal Toxicol. 2024;36(6):406-419. doi:10.1080/08958378.2024.2374394
Öztoprak Ü, Aksoy E, Yayıcı Köken Ö, et al. Clinical characteristics and neurological findings of pediatric patients with acute carbon monoxide intoxication. J Pediatr Res. 2021;8(1):20-28. doi:10.4274/jpr.galenos.2020.17894
Beppu T. The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. AJNR Am J Neuroradiol. 2014;35(4):625-631. doi:10.3174/ajnr.A3489
von Kalle T, Fabig-Moritz C, Heumann H, Winkler P. Incidental findings in paranasal sinuses and mastoid cells: a cross-sectional magnetic resonance imaging (MRI) study in a pediatric radiology department. Rofo. 2012;184(7):629-634. doi:10.1055/s-0032-1312861
Dremmen MHG, Papp D, Hernandez-Tamames JA, et al. The influence of nonaerated paranasal sinuses on DTI parameters of the brain in 6- to 9-year-old children. AJNR Am J Neuroradiol. 2023;44(11):1318-1324. doi:10.3174/ajnr.A8033
Lee S, Fernandez J, Mirjalili SA, Kirkpatrick J. Pediatric paranasal sinuses-development, growth, pathology, and functional endoscopic sinus surgery. Clin Anat. 2022;35(6):745-761. doi:10.1002/ca.23888
Swinarew AS, Stanula AJ, Gabor J, et al. The influence of chlorine in indoor swimming pools on the composition of breathing phase of professional swimmers. Respir Res. 2020;21(1):88. doi:10.1186/s12931-020-01350-y
Ross JA, Seitz SR, Wernicki P, Fielding RR, Charlton N. First aid for pool chemical exposure: a narrative review. Cureus. 2021;13(7):e16755. doi:10.7759/cureus.16755
Wen T, Liang J, Wei Y, Lin W, Pan L. Analysis of prognosis of neurological sequelae in children with carbon monoxide poisoning. Sci Rep. 2024;14(1):29972. doi:10.1038/s41598-024-81634-1

Details

Primary Language

English

Subjects

Pediatric Emergency

Journal Section

Research Article

Authors

Handan Ayhan Akoğlu ^*
0000-0001-9074-8466
Türkiye

Muhammet Bulut
0000-0002-5963-1267
Türkiye

Gökhan Tonkaz
0000-0001-5759-0206
Türkiye

Hilmi Furkan Arslan
0000-0001-8986-3774
Türkiye

Emine Tekin
0000-0002-5115-8890
Türkiye

Bekir Yükcü
0000-0003-1661-7024
Türkiye

Publication Date

July 16, 2026

Submission Date

May 6, 2026

Acceptance Date

June 12, 2026

Published in Issue

Year 2026 Volume: 8 Number: 4

IZ

https://izlik.org/JA45FC47XP

Cite

RIS / Bibtex

APA

Akoğlu, H. A., Bulut, M., Tonkaz, G., Arslan, H. F., Tekin, E., & Yükcü, B. (2026). Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study. Anatolian Current Medical Journal, 8(4), 696-704. https://izlik.org/JA45FC47XP

AMA

1.Akoğlu HA, Bulut M, Tonkaz G, Arslan HF, Tekin E, Yükcü B. Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study. Anatolian Curr Med J / ACMJ / acmj. 2026;8(4):696-704. https://izlik.org/JA45FC47XP

Chicago

Akoğlu, Handan Ayhan, Muhammet Bulut, Gökhan Tonkaz, Hilmi Furkan Arslan, Emine Tekin, and Bekir Yükcü. 2026. “Biochemical, Cardiac, and Neuroimaging Correlates of Pediatric Carbon Monoxide Poisoning: A Single-Source Mass Exposure Study”. Anatolian Current Medical Journal 8 (4): 696-704. https://izlik.org/JA45FC47XP.

EndNote

Akoğlu HA, Bulut M, Tonkaz G, Arslan HF, Tekin E, Yükcü B (July 1, 2026) Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study. Anatolian Current Medical Journal 8 4 696–704.

IEEE

[1]H. A. Akoğlu, M. Bulut, G. Tonkaz, H. F. Arslan, E. Tekin, and B. Yükcü, “Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 4, pp. 696–704, July 2026, [Online]. Available: https://izlik.org/JA45FC47XP

ISNAD

Akoğlu, Handan Ayhan - Bulut, Muhammet - Tonkaz, Gökhan - Arslan, Hilmi Furkan - Tekin, Emine - Yükcü, Bekir. “Biochemical, Cardiac, and Neuroimaging Correlates of Pediatric Carbon Monoxide Poisoning: A Single-Source Mass Exposure Study”. Anatolian Current Medical Journal 8/4 (July 1, 2026): 696-704. https://izlik.org/JA45FC47XP.

JAMA

1.Akoğlu HA, Bulut M, Tonkaz G, Arslan HF, Tekin E, Yükcü B. Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study. Anatolian Curr Med J / ACMJ / acmj. 2026;8:696–704.

MLA

Akoğlu, Handan Ayhan, et al. “Biochemical, Cardiac, and Neuroimaging Correlates of Pediatric Carbon Monoxide Poisoning: A Single-Source Mass Exposure Study”. Anatolian Current Medical Journal, vol. 8, no. 4, July 2026, pp. 696-04, https://izlik.org/JA45FC47XP.

Vancouver

1.Handan Ayhan Akoğlu, Muhammet Bulut, Gökhan Tonkaz, Hilmi Furkan Arslan, Emine Tekin, Bekir Yükcü. Biochemical, cardiac, and neuroimaging correlates of pediatric carbon monoxide poisoning: a single-source mass exposure study. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Jul. 1;8(4):696-704. Available from: https://izlik.org/JA45FC47XP