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Karbonmonoksit Zehirlenmesinde Seri Laktat Ölçümünün Değerlendirilmesi

Year 2025, Volume: 8 Issue: 3, 115 - 119, 30.09.2025
https://doi.org/10.54996/anatolianjem.1679146

Abstract

Amaç: Karbonmonoksit akut zehirlenmelere neden olabilen beyin, kalp, böbrek gibi organları etkileyen bir gazdır. CO zehirlenmesi hastalarındaki laktat klirensini araştıran çalışma sayısı kısıtlıdır. Çalışmamızın primer sonlanım amacı; laktat klirensinin demografik özellikler, hiperbarik tedavi ve sonlanım arasında fark olup olmadığını saptamaktır.
Gereç ve Yöntemler: Çalışmamız retrospektif olarak yapıldı. 18 yaş üstü karboksihemoglobin düzeyi >% 10 olan ve en az 2 venöz kan gazı sonucu bulunan hastalar dahil edildi. Hastaların demografik özelikleri, ilk ve ikinci kan gazında karboksihemoglobin, laktat değerleri, kan gazının alınma saatleri, hiperbarik tedavisi alıp almadıkları ve hastaların sonlanımı kaydedildi.
Bulgular: Çalışmamıza toplam 272 hasta dahil edildi. İlk karboksihemoglobin değeri ortalama 22,8±8,6 (10,0-60.9) saptandı. İlk laktat değeri ortalama 2,3±1,8 (0,1-18,0) saptandı. Kan gazında laktat klirensinde %20 den fazla düşme; 1. saatte 37 hastada (%51,4), 2. saatte 43 hastada (%66,2), 3. saatte 75 hastada (%77,3), 4. saatte 29 hastada (%76,3) saptandı. Kan gazı alınma saatlerine göre ayrılarak karşılaştırıldığında ilk ve ikinci CO ve laktat değerleri arasında anlamlı fark saptanmadı. Laktat klirensinde %20 den fazla düşmede; yaş, cinsiyet ve karboksihemoglobin değerleri ve hastanın sonlanımı ile istatiksel anlamsız saptandı.
Sonuç: Hastanın sonlanımı ile laktat klirensi arasında istatiksel anlamlılık saptanmamıştır.

References

  • Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. State of the Art. Health effects of outdoor air pollution. Am J Respir Crit Care Med. 153: 477-98, 1996.
  • Kandis H, Katırcı Y, Çakır Z, Aslan Ş, Uzkeser M, Bilir Ö. Acil Servise Karbonmonoksit Entoksikasyonu ile Başvuran Olguların Geriye Dönük Analizi. Akademik Acil Tıp Dergisi. 5: 21–5, 2007.
  • Aslan S. Karbonmonoksid Zehirlenmesi ile Başvuran Hastalarda İskemiye Bağlı Miyokard Hasarının Araştırılması. Uzmanlık Tezi; Erzurum 2003
  • Choi SA, Choi Is. Clinical Manifestations and Complications in Carbon Monoxide İntoxication. J Korean Neurol Assoc. 16: 500-505, 1998.
  • Keith W, Van Meter. Carbon monoxide Poisoning. In Tintinalli JE, Kelen GD, Stapczynski JS (eds).Emergency Medicine A Comprehensive Study Guide, New York: McGraw-Hill, pp: 1302-06, 2000.
  • Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3:12.
  • Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964;143:1457–9.
  • Jansen TC, Van Bommel J, Woodward R, Mulder PG, Bakker J. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit Care Med. 2009;37:2369–74.
  • Van Beest PA, Brander L, Jansen SP, Rommes JH, Kuiper MA, Spronk PE. Cumulative lactate and hospital mortality in ICU patients. Ann Intensive Care. 2013;3:6.
  • Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis*. Crit Care Med. 2014;42:2118–25.
  • Ozkan S, Salt O, Durukan P, et al. The relationship among plasma copeptin, carboxyhemoglobin, and lactate levels in carbon monoxide poisoning. Hum Exp Toxicol. 2020;39(3):311-318.
  • Inoue S, Saito T, Tsuji T, et al. Lactate as a prognostic factor in carbon monoxide poisoning: a case report. Am J Emerg Med. 2008;26(8):966.e1-966.e9663.
  • İncekaya Y, Feyizi H, Bayraktar S et al. Cabon Monoxide Poisoning And Hyperbaric Oxygen Therapy. 2017;33(2):114-8.
  • Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45:524–528.
  • Wang B, Li Z, Xu W, et al. Prognostic significance of serum lactate levels in patients with sepsis: a systematic review and meta-analysis. J Crit Care. 2015;30:271–275.
  • Lokhandwala S, Andersen LW, Nair S, et al. Absolute and relative lactate clearance for predicting mortality in patients with septic shock. J Crit Care. 2017;37:179–184.
  • Nañagas KA, Jones MP. Carbon monoxide poisoning: pathogenesis, management, and outcome. Emerg Med Clin N Am. 2022;40(2):283–312.
  • Yildiz MN, Gunay N, Eroglu SE, et al. Evaluation of prognostic factors in carbon monoxide poisoning. North Clin Istanb. 2019;6(2):141–145.
  • Eroglu SE, Yildiz MN, Gunay N, et al. Relationship between serum lactate level and clinical outcomes in patients with carbon monoxide poisoning. North Clin Istanb. 2019;6(2):141–145.
  • Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–746.
  • Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcomes in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637–1642.
  • Walker CA, Griffith DM, Gray AJ. Early lactate clearance is associated with improved survival in sepsis patients. J Crit Care. 2013;28(6):832–837.
  • Scott HF, Donoghue AJ, Gaieski DF, et al. The utility of early lactate clearance in children with sepsis and septic shock. J Pediatr. 2016;170:149–155.
  • Wang S, Liu Y, Liu H, Wang P, Wang W. Clinical application of BIS combined with LCR in assessing brain function and prognosis of patients with severe carbon monoxide poisoning. Clin Neurol Neurosurg. 2023 Jan;224:107556.

Evaluation of Serial Lactate Measurements in Carbon Monoxide Poisoning

Year 2025, Volume: 8 Issue: 3, 115 - 119, 30.09.2025
https://doi.org/10.54996/anatolianjem.1679146

Abstract

Aim: Carbon monoxide is a gas that can cause acute poisoning and affect organs such as the brain, heart, and kidneys. The number of studies investigating lactate clearance in patients with CO poisoning is limited. The primary endpoint of our study is to determine whether there is a difference in lactate clearance according to demographic characteristics, hyperbaric oxygen therapy, and clinical outcomes.
Material and Methods: Our study was conducted retrospectively. Patients over the age of 18 with carboxyhemoglobin levels >10% and at least two venous blood gas results were included. Demographic characteristics, carboxyhemoglobin and lactate levels in the first and second blood gas analyses, the timing of blood gas sampling, whether or not they received hyperbaric oxygen therapy, and patient outcomes were recorded.
Results: A total of 272 patients were included in our study. The mean initial carboxyhemoglobin level was 22.8±8.6 (10.0–60.9). The mean initial lactate level was 2.3±1.8 (0.1–18.0). A decrease in lactate clearance of more than 20% was observed in 37 patients (51.4%) at the 1st hour, 43 patients (66.2%) at the 2nd hour, 75 patients (77.3%) at the 3rd hour, and 29 patients (76.3%) at the 4th hour. When grouped according to the timing of blood gas sampling, no significant difference was found between the first and second CO and lactate levels. A decrease in lactate clearance of more than 20% was not statistically significant in terms of age, gender, carboxyhemoglobin levels, and patient outcomes.
Conclusion: No statistically significant association was found between patient outcomes and lactate clearance.

References

  • Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. State of the Art. Health effects of outdoor air pollution. Am J Respir Crit Care Med. 153: 477-98, 1996.
  • Kandis H, Katırcı Y, Çakır Z, Aslan Ş, Uzkeser M, Bilir Ö. Acil Servise Karbonmonoksit Entoksikasyonu ile Başvuran Olguların Geriye Dönük Analizi. Akademik Acil Tıp Dergisi. 5: 21–5, 2007.
  • Aslan S. Karbonmonoksid Zehirlenmesi ile Başvuran Hastalarda İskemiye Bağlı Miyokard Hasarının Araştırılması. Uzmanlık Tezi; Erzurum 2003
  • Choi SA, Choi Is. Clinical Manifestations and Complications in Carbon Monoxide İntoxication. J Korean Neurol Assoc. 16: 500-505, 1998.
  • Keith W, Van Meter. Carbon monoxide Poisoning. In Tintinalli JE, Kelen GD, Stapczynski JS (eds).Emergency Medicine A Comprehensive Study Guide, New York: McGraw-Hill, pp: 1302-06, 2000.
  • Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3:12.
  • Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964;143:1457–9.
  • Jansen TC, Van Bommel J, Woodward R, Mulder PG, Bakker J. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit Care Med. 2009;37:2369–74.
  • Van Beest PA, Brander L, Jansen SP, Rommes JH, Kuiper MA, Spronk PE. Cumulative lactate and hospital mortality in ICU patients. Ann Intensive Care. 2013;3:6.
  • Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis*. Crit Care Med. 2014;42:2118–25.
  • Ozkan S, Salt O, Durukan P, et al. The relationship among plasma copeptin, carboxyhemoglobin, and lactate levels in carbon monoxide poisoning. Hum Exp Toxicol. 2020;39(3):311-318.
  • Inoue S, Saito T, Tsuji T, et al. Lactate as a prognostic factor in carbon monoxide poisoning: a case report. Am J Emerg Med. 2008;26(8):966.e1-966.e9663.
  • İncekaya Y, Feyizi H, Bayraktar S et al. Cabon Monoxide Poisoning And Hyperbaric Oxygen Therapy. 2017;33(2):114-8.
  • Shapiro NI, Howell MD, Talmor D, et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005;45:524–528.
  • Wang B, Li Z, Xu W, et al. Prognostic significance of serum lactate levels in patients with sepsis: a systematic review and meta-analysis. J Crit Care. 2015;30:271–275.
  • Lokhandwala S, Andersen LW, Nair S, et al. Absolute and relative lactate clearance for predicting mortality in patients with septic shock. J Crit Care. 2017;37:179–184.
  • Nañagas KA, Jones MP. Carbon monoxide poisoning: pathogenesis, management, and outcome. Emerg Med Clin N Am. 2022;40(2):283–312.
  • Yildiz MN, Gunay N, Eroglu SE, et al. Evaluation of prognostic factors in carbon monoxide poisoning. North Clin Istanb. 2019;6(2):141–145.
  • Eroglu SE, Yildiz MN, Gunay N, et al. Relationship between serum lactate level and clinical outcomes in patients with carbon monoxide poisoning. North Clin Istanb. 2019;6(2):141–145.
  • Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–746.
  • Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcomes in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637–1642.
  • Walker CA, Griffith DM, Gray AJ. Early lactate clearance is associated with improved survival in sepsis patients. J Crit Care. 2013;28(6):832–837.
  • Scott HF, Donoghue AJ, Gaieski DF, et al. The utility of early lactate clearance in children with sepsis and septic shock. J Pediatr. 2016;170:149–155.
  • Wang S, Liu Y, Liu H, Wang P, Wang W. Clinical application of BIS combined with LCR in assessing brain function and prognosis of patients with severe carbon monoxide poisoning. Clin Neurol Neurosurg. 2023 Jan;224:107556.
There are 24 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Gökçe Özbay Yenice 0000-0002-2320-7691

Ali Kaan Ataman 0000-0002-1248-6226

Emel Altıntaş 0000-0003-4487-5661

Publication Date September 30, 2025
Submission Date April 23, 2025
Acceptance Date June 20, 2025
Published in Issue Year 2025 Volume: 8 Issue: 3

Cite

AMA Özbay Yenice G, Ataman AK, Altıntaş E. Evaluation of Serial Lactate Measurements in Carbon Monoxide Poisoning. Anatolian J Emerg Med. September 2025;8(3):115-119. doi:10.54996/anatolianjem.1679146