Research Article
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Year 2019, Volume: 1 Issue: 1, 15 - 20, 01.03.2019

Sinem Doğruyol , İlker Akbaş , Zeynep Çakır

Abstract

Amaç: Bu çalışma bir üniversite hastanesine, karbonmonoksit zehirlenmesi tanısı ile başvuran vakalarının klinik durumunu, tedavisini ve morbiditesini analiz etmeyi ve epidemiyolojik verilerini tanımlamayı amaçlamaktadır. Ek olarak, bu çalışmada belirtilen vakaların kan testlerinin sonuçları ayrıntılı olarak değerlendirilmiştir.

Gereç ve Yöntem: Bu retrospektif çalışmada, 2014-2018 yılları arasında karbonmonoksitin toksik etkileri tanısı alan hastalar değerlendirildi. Hastaların dosyalarından elde edilen veriler arasında yaş, cinsiyet, altta yatan komorbiditeler, sigara kullanımı, alkol kötüye kullanımı öyküsü, vital bulgular, klinik belirtiler, laboratuvar ve görüntüleme sonuçları, tedavi, sonuç, zehirlenme kaynağı ve mevsimsel değişken yer alıyordu.

Bulgular: Çalışmaya toplam 653 hasta dahil edildi. Kış mevsiminde yapılan başvuruların diğer mevsimlere anlamlı olarak daha yüksek olduğu tespit edildi (p <0.001). En sık görülen semptomlar baş ağrısı (% 62.3), bulantı (% 42.3), ani bilinç kaybı (% 15.9) ve baş dönmesi (% 12.1) idi. Laktat seviyeleri ile karboksihemoglobin değerleri (r = 0.257, p <0.001) ve troponin I düzeyleri (r = 0.267, p <0.001) arasında pozitif korelasyon gösterildi. > 2 mmol / L’lik bir kan laktat konsantrasyonu, hiperbarik oksijen tedavisi ihtiyacını öngörmek için% 40 hassasiyet ve% 75 özgüllük ile ilişkilendirildi. Hiperbarik oksijen tedavisi grubu daha uzun bir hastanede kalış süresine sahipti, bu durum istatistiksel olarak anlamlıydı (ortalama fark -0.98;% 95 CI = -1.38, -0.57) (p <0.001).

Sonuç: Acil tıp klinikleri karbonmonoksit zehirlenmesi vakalarında neredeyse tek başına savaşmaktadır. Bu nedenle yeni bakış açılarına ihtiyaç vardır. Laktat, hastaların yönetiminde bir seçenek olarak güvenle kullanılabilir. 

Keywords

karbonmonoksit intoksikasyon laktat zehirlenme

References

  • 1. Huang CC, Ho CH, Chen YC, Lin HJ, Hsu CC, Wang JJ, et al. Demographic and clinical characteristics of carbon monoxide poisoning: nationwide data between 1999 and 2012 in Taiwan. Scand J Trauma Resusc Emerg Med. 2017;25:70.
  • 2. 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. 2007; 5: 21–5.
  • 3. Sircar K, Clower J, kyong Shin M, Bailey C, King M, Yip, F. Carbon monoxide poisoning deaths in the United States, 1999 to 2012. Am J Emerg Med. 2015;33:1140-5.
  • 4. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339:1603–8.
  • 5. Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. J Neurol Sci 2007;262:122–30.
  • 6. 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.
  • 7. Kao LW, Nanagas KA. Carbon monoxide poisoning. Emerg Med Clin North Am. 2004;22: 985–1018). HBOT is suggested for patients with severe CO poisoning
  • 8. Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med. 2009;360:1217–25.
  • 9. Huang CC, Chung MH, Weng SF, Chien CC, Lin SJ, Lin HJ, et al. Long-term prognosis of patients with carbon monoxide poisoning: a nationwide cohort study. PLoS One. 2014;9:e105503.
  • 10. Wu L, Wang R. Carbon monoxide: endogenous production, physiological functions, and pharmacological applications. Pharmacol Rev 2005;57:585–630.
  • 11. Duenas-Laita A, Ruiz-Mambrilla M, Gandia F, Cerda R, Martín-Escudero JC, Pérez-Castrillón JL, et al. Epidemyelogy of acute carbon monoxide poisoning in a Spanish Region. J Toxicol Clin Toxicol. 2001; 39: 53–7.
  • 12. Blumenthal I. Carbon monoxide poisoning. J R Soc Med. 2001;94:270-2.
  • 13. Ocak T, Tekin E, Basturk M, Duran A, Serinken M, Emet M. Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial. Am J Emerg Med. 2016; 34: 2140-5.
  • 14. Ku CH, Hung HM, Leong WC, Chen HH, Lin JL, Huang WH, et al. Outcome of patients with carbon monoxide poisoning at a far-east poison center. PLoS One. 2015;10:e0118995.
  • 15. Benaissa ML, Megarbane B, Borron SW, Baud FJ. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning? Intensive Care Med. 2003;29:1372-5. doi:10.1007/s00134-003-1866-0.
  • 16. Moon JM, ShinMH, Chun BJ. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol 2011;30:836–43.
  • 17. Wolf SJ, Lavonas EJ, Sloan EP, Jagoda AS. American College of Emergency Physicians. Critical issues in the management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med 2008;51:138–52.

Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum

Year 2019, Volume: 1 Issue: 1, 15 - 20, 01.03.2019

Sinem Doğruyol , İlker Akbaş , Zeynep Çakır

Abstract

Objective:  This report describes the
epidemiology and analyses the clinic status, treatment, morbidity of carbonmonoxide
intoxication cases in a university hospital. Furthermore, the results of blood
tests of cases mentioned in this study were evaluated in detail.



Materials and
Methods: In this retrospective
study, patients diagnosed with toxic effects of carbonmonoxide were evaluated between
years 2014-2018. The data extracted from the
patients’ files included seasonal variation, age,
gender, underlying comorbidities, smoking and alcohol abuse history, vital
parameters, clinical manifestations and source of poisoning, laboratory and
imaging records, treatment and outcome.



Results:  A total of 653 patients were included in the study. Admissions
during the winter was found to be higher that other seasons with a significant
difference (p < 0.001). The most frequent symptoms were headache (%62.3),
nausea (%42.3), sudden loss of consciousness (%15.9) and dizziness (%12.1). Lactate
levels were positively correlated with carboxyhemoglobin values (r= 0.257, p
< 0.001) and troponin I levels (r=0.267, p<0.001). A blood lactate
concentration >2 mmol/L was associated with %40 sensitivity and %75
specificity for predicting hyperbaric oxygen
therapy requirement. Hyperbaric oxygen
therapy group had a longer hospitalization period, which was
statistically significant (mean difference -0.98; 95% CI = -1.38, -0.57) (p
<0.001).



Conclusion:  Emergency
medicine clinics are fighting almost alone in carbonmonoxide
poisoning cases. Now it is required to develop new perspectives in these cases.
Lactate can be used safely in the management of patients as an option. 

Keywords

Carbonmonoxide Intoxication Lactate Poisoning

References

  • 1. Huang CC, Ho CH, Chen YC, Lin HJ, Hsu CC, Wang JJ, et al. Demographic and clinical characteristics of carbon monoxide poisoning: nationwide data between 1999 and 2012 in Taiwan. Scand J Trauma Resusc Emerg Med. 2017;25:70.
  • 2. 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. 2007; 5: 21–5.
  • 3. Sircar K, Clower J, kyong Shin M, Bailey C, King M, Yip, F. Carbon monoxide poisoning deaths in the United States, 1999 to 2012. Am J Emerg Med. 2015;33:1140-5.
  • 4. Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339:1603–8.
  • 5. Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. J Neurol Sci 2007;262:122–30.
  • 6. 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.
  • 7. Kao LW, Nanagas KA. Carbon monoxide poisoning. Emerg Med Clin North Am. 2004;22: 985–1018). HBOT is suggested for patients with severe CO poisoning
  • 8. Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med. 2009;360:1217–25.
  • 9. Huang CC, Chung MH, Weng SF, Chien CC, Lin SJ, Lin HJ, et al. Long-term prognosis of patients with carbon monoxide poisoning: a nationwide cohort study. PLoS One. 2014;9:e105503.
  • 10. Wu L, Wang R. Carbon monoxide: endogenous production, physiological functions, and pharmacological applications. Pharmacol Rev 2005;57:585–630.
  • 11. Duenas-Laita A, Ruiz-Mambrilla M, Gandia F, Cerda R, Martín-Escudero JC, Pérez-Castrillón JL, et al. Epidemyelogy of acute carbon monoxide poisoning in a Spanish Region. J Toxicol Clin Toxicol. 2001; 39: 53–7.
  • 12. Blumenthal I. Carbon monoxide poisoning. J R Soc Med. 2001;94:270-2.
  • 13. Ocak T, Tekin E, Basturk M, Duran A, Serinken M, Emet M. Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial. Am J Emerg Med. 2016; 34: 2140-5.
  • 14. Ku CH, Hung HM, Leong WC, Chen HH, Lin JL, Huang WH, et al. Outcome of patients with carbon monoxide poisoning at a far-east poison center. PLoS One. 2015;10:e0118995.
  • 15. Benaissa ML, Megarbane B, Borron SW, Baud FJ. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning? Intensive Care Med. 2003;29:1372-5. doi:10.1007/s00134-003-1866-0.
  • 16. Moon JM, ShinMH, Chun BJ. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol 2011;30:836–43.
  • 17. Wolf SJ, Lavonas EJ, Sloan EP, Jagoda AS. American College of Emergency Physicians. Critical issues in the management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med 2008;51:138–52.
There are 17 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Sinem Doğruyol

İlker Akbaş

Zeynep Çakır

Publication Date March 1, 2019
Submission Date January 29, 2019
Published in Issue Year 2019 Volume: 1 Issue: 1

Cite

APA Doğruyol, S., Akbaş, İ., & Çakır, Z. (2019). Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum. Eurasian Journal of Toxicology, 1(1), 15-20.
AMA Doğruyol S, Akbaş İ, Çakır Z. Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum. Eurasian J Tox. March 2019;1(1):15-20.
Chicago Doğruyol, Sinem, İlker Akbaş, and Zeynep Çakır. “Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum”. Eurasian Journal of Toxicology 1, no. 1 (March 2019): 15-20.
EndNote Doğruyol S, Akbaş İ, Çakır Z (March 1, 2019) Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum. Eurasian Journal of Toxicology 1 1 15–20.
IEEE S. Doğruyol, İ. Akbaş, and Z. Çakır, “Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum”, Eurasian J Tox, vol. 1, no. 1, pp. 15–20, 2019.
ISNAD Doğruyol, Sinem et al. “Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum”. Eurasian Journal of Toxicology 1/1 (March 2019), 15-20.
JAMA Doğruyol S, Akbaş İ, Çakır Z. Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum. Eurasian J Tox. 2019;1:15–20.
MLA Doğruyol, Sinem et al. “Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum”. Eurasian Journal of Toxicology, vol. 1, no. 1, 2019, pp. 15-20.
Vancouver Doğruyol S, Akbaş İ, Çakır Z. Demographic and Clinical Characteristics of Carbon Monoxide Poisoning: Data Between 2014 and 2018 in Erzurum. Eurasian J Tox. 2019;1(1):15-20.
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