Evaluation of Patients Presenting to the Pediatric Emergency Department with Carbon Monoxide Poisoning

Year 2022, , 276 - 281, 30.12.2022

Aysun Tekeli , Ahmet Bolat , Bülent Ünay

https://doi.org/10.18678/dtfd.1145278

Abstract

Aim: Carbon monoxide poisoning is one of the significant causes of intoxication and presentation to pediatric emergency departments, especially in winter. The primary aim of this study was to evaluate the demographic characteristics, and clinical and laboratory findings of pediatric patients who presented to the pediatric emergency department with carbon monoxide poisoning, and the secondary aim was to examine the laboratory values of the patients with impaired consciousness.
Material and Methods: The demographic and clinical characteristics and laboratory values of 162 patients presented to the pediatric emergency department due to carbon monoxide poisoning between 2017 and 2020 were retrospectively analyzed. The laboratory parameters of the patients with and without symptoms of impaired consciousness were compared.
Results: The mean age of the patients was 8.94±5.33 years, and the gender distribution was homogenous. The highest frequency of presentation was during winter. Nausea, vomiting, and headache were the most common symptoms. Fifteen of the patients had impaired consciousness. While the laboratory values of the patients were generally within normal ranges, patients with high carboxyhemoglobin, lactate, and troponin values, and low pH were encountered. The carboxyhemoglobin and lactate levels of patients with impaired consciousness were found to be significantly higher than the patients without impaired consciousness (p<0.001 and p=0.019, respectively).
Conclusion: Elevated carboxyhemoglobin and lactate levels were associated with impaired consciousness. Although carboxyhemoglobin levels are important for diagnosis and clinical follow-up, they should not be used as the only marker. High lactate and troponin levels, and low pH should also be taken into account.

Keywords

Carbon monoxide, children, impaired consciousness, poisoning

Çocuk Acile Karbonmonoksit Zehirlenmesi ile Başvuran Hastaların Değerlendirilmesi

Abstract

Amaç: Karbonmonoksit zehirlenmeleri özellikle kış mevsiminde zehirlenme ile çocuk acil servisine başvuruların önemli nedenlerinden biridir. Bu çalışmanın birincil amacı çocuk acil servisine karbonmonoksit zehirlenmesi ile başvuran çocuk hastaların demografik özellikleri ile klinik ve laboratuvar bulgularını değerlendirmek, ikincil amacı ise karbonmonoksit zehirlenmesine bağlı bilinç değişikliği gelişen hastaların laboratuvar değerlerini incelemektir.
Gereç ve Yöntemler: 2017 ve 2020 yılları arasında çocuk acil servisine karbonmonoksit zehirlenmesi nedeniyle başvurmuş olan 162 hastanın demografik ve klinik özellikleri ile laboratuvar değerleri geriye dönük olarak incelendi. Bilinç değişikliği semptomu olan ve olmayan hastaların laboratuvar parametreleri karşılaştırıldı.
Bulgular: Hastaların ortalama yaşı 8,94±5,33 yıl idi ve cinsiyet dağılımları homojendi. En yüksek başvuru sıklığı kış mevsimindeydi. Bulantı, kusma ve baş ağrısı en sık görülen semptomlardı. Hastaların on beşinde bilinç değişikliği vardı. Hastaların laboratuvar değerleri genel olarak normal aralıklarda iken karboksihemoglobin, laktat ve troponin değerleri yüksek olan ve pH değeri düşük olan hastalar da olduğu tespit edildi. Bilinç değişikliği olan hastaların karboksihemoglobin ve laktat düzeyi, bilinç değişikliği olmayan hastalara göre anlamlı şekilde daha yüksek bulundu (sırasıyla p<0,001 ve p=0,019).
Sonuç: Yüksek karboksihemoglobin ve laktat seviyesi bilinç değişikliği ile ilişkili bulunmuştur. Karboksihemoglobin düzeyi tanı ve klinik takip için önemli olmakla birlikte tek başına bir belirteç olarak kullanılmamalıdır. Yüksek laktat ve troponin değerleri ve düşük pH değeri de dikkate alınmalıdır.

Keywords

karbonmonoksit, çocuk, Bilinç değişikliği, zehirlenme

References

• Byard RW. Carbon monoxide - the silent killer. Forensic Sci Med Pathol. 2019;15(1):1-2.
• Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339(22):1603-8.
• Uysalol M, Paslı Uysalol E, Kayaoğlu S, Varol Saraçoğlu G. A retrospective analysis of pediatric patients admitted to the pediatric emergency service for carbon monoxide intoxication. Balkan Med J. 2011;28(3):237-43.
• Tomaszewski C. Carbon monoxide. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, editors. Goldfrank's toxicologic emergencies. 11th ed. New York: McGraw-Hill; 2019.
• Yetiş Y, Karbeyaz K, Güneş A. 20-year analysis of deaths due to carbon monoxide poisoning in Eskisehir. ADYÜ Sağlık Bil Derg. 2017;3(1):396-406. Turkish.
• cdc.gov [Internet]. Centers for Disease Control and Prevention. Carbon monoxide poisoning. [Updated: 2018 September 16; Cited: 2019 March 28]. Available from: https://www.cdc.gov/co/.
• Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning--a public health perspective. Toxicology. 2000;145(1):1-14.
• Shimazu T. Pathophysiology, myths and mysteries of acute carbon monoxide poisoning. Chudoku Kenkyu. 2006;19(1):23-33. Japanese.
• Hampson NB, Hauff NM. Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture? Am J Emerg Med. 2008;26(6):665-9.
• Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: A randomized clinical trial. JAMA. 2010;303(8):739-46.
• Aydın A, Kaçmaz O, Öterkuş M, Miniksar ÖH. The relationship between MPV, RDW, lactate, sodium and albumin levels and mortality in intensive care patients. Dicle Med J. 2022;49(1):168-75. Turkish.
• Clerico A, Aimo A, Cantinotti M. High-sensitivity cardiac troponins in pediatric population. Clin Chem Lab Med. 2021;60(1):18-32.
• Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, et al. Hyperbaric oxygen for acute carbonmonoxide poisoning. N Engl J Med. 2002;347(14):1057-67.
• Baum CR. What’s new in pediatric carbon monoxide poisoning? Clin Ped Emerg Med. 2008;9(1):43-6.
• Cho CH, Chiu NC, Ho CS, Peng CC. Carbon monoxide poisoning in children. Pediatr Neonatol. 2008;49(4):121-5.
• Kurt F, Bektaş Ö, Kalkan G, Öncel MY, Yakut HI, Kocabaş CN. Does age affect presenting symptoms in children with carbon monoxide poisoning? Pediatr Emerg Care. 2013;29(8):916-21.
• Ait El Cadi M, Khabbal Y, Idrissi L. Carbon monoxide poisoning in Morocco during 1999-2007. J Forensic Leg Med. 2009;16(7):385-7.
• Salameh S, Amitai Y, Antopolsky M, Rott D, Stalnicowicz R. Carbon monoxide poisoning in Jerusalem: epidemiology and risk factors. Clin Toxicol (Phila). 2009;47(2):137-41.
• Jüttner B, Busch HJ, Callies A, Dormann H, Janisch T, Kaiser G, et al. S2k guideline diagnosis and treatment of carbon monoxide poisoning. Ger Med Sci. 2021;19:Doc13.
• Eichhorn L, Thudium M, Jüttner B. The diagnosis and treatment of carbon monoxide poisoning. Dtsch Arztebl Int. 2018;115(51-52):863-70.
• Nañagas KA, Penfound SJ, Kao LW. Carbon monoxide toxicity. Emerg Med Clin North Am. 2022;40(2):283-312.
• Ertekin B, Koçak S, Acar T, Öztürk E, Demir LS. Role of whole blood markers in carbon monoxide poisoning. Cukurova Med J. 2019;44(Suppl 1):197-201. Turkish.
• Tursun S, Alpcan A, Karahan İ. The retrospective analysis of carbon monoxide poisoning admissions to pediatric emergency room of a university hospital. KÜ Tıp Fak Derg. 2020;22(2):199-207. Turkish.
• Coşkun A, Eren FA, Eren ŞH, Korkmaz İ. Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels: Neuropsychoses in carbon monoxide poisoning. Am J Emerg Med. 2019;37(7):1254-9.
• Karaman K, Armagan HH. Predictive value of platelet lymphocyte ratio in carbon monoxide poisoning. Ann Med Res. 2021;28(9):1754-7.
• Atiş ŞE, Sarıkaya T, Yamaç A. The relationship of blood parameters with the severity of carbon monoxide poisoning. J Contemp Med. 2022;12(4):481-4.
• Bağcı 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):1121-6.
• Keleş A, Demircan A, Kurtoğlu G. Carbon monoxide poisoning: how many patients do we miss? Eur J Emerg Med. 2008;15(3):154-7.
• Bleecker ML. Carbon monoxide poisoning. Handb Clin Neurol 2015;131:191-203.
• Yurtseven A, Ulaş Saz E. Carboxyhemoglobin levels should be considered in carbon monoxide poisoning. J Curr Pediatr. 2017;15(2):10-8. Turkish.
• Guzman JA. Carbon monoxide poisoning. Crit Care Clin. 2012;28(4):537-48.
• Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med. 2009;360(12):1217-25.
• Besli GE, Ergüven M, Karadoğan M, Yılmaz Ö. Carbon Monoxide Poisoning in Children. Eurasian J Emerg Med. 2010;9(1):26-30. Turkish.
• Benaissa ML, Mégarbane B, Borron SW, Baud FJ. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning? Intensive Care Med. 2003;29(8):1372-5.
• Cha YS, Cha KC, Kim OH, Lee KH, Hwang SO, Kim H. Features and predictors of myocardial injury in carbon monoxide poisoned patients. Emerg Med J. 2014;31(3):210-5.
• Boztepe H, Yalaki Z, Bilge YD. Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children. Turk Arch Pediatr. 2014;49(4): 314-22.