The Relationship of Lactate Levels with Carboxyhemoglobin Levels and Clinical Findings in Patients Admitted with Acute Carbon Monoxide Poisoning

Abstract

Aim: Acute carbon monoxide (CO) poisoning is a potentially mortal, though preventable, condition. Mild poisoning presents with non-specific symptoms, such as fatigue, headache, nausea and vomiting, whereas severe exposure to CO can result in loss of consciousness, coma, and death. The aim of this study was to investigate the utility of lactate and carboxyhemoglobin (COHb) levels in the clinical presentation and treatment of patients with acute CO poisoning. Material and Methods: Data were obtained from the hospital information system and patient files with ICD-10 code “T58: Toxic effects of CO”. The blood parameters and vital signs of patients at admission, causes of poisoning, time to hospital, and Glasgow coma scores during admission were recorded. Within related and relevant complications of CO intoxication and data concerning treatment plans and hospitalization status were recorded. Results: A statistically significant difference was found between COHb and lactate levels of patients who did and did not develop neurological and cardiac complications (p<0.001). Moreover, a statistically significant difference was found in COHb and lactate levels among patients who did or did not receive hyperbaric oxygen therapy, and who were hospitalized or not (p<0.001). As looking for biochemical profile, significant correlations was found between COHb and pH, base excess, and bicarbonate and lactate levels. Conclusion: This study shows that COHb and lactate levels at admission to the emergency department are significant for prognosis, follow-up, and treatment of patients with CO poisoning. Elevated lactate and COHb levels may also found to be associated with neurological and cardiac complications.

Keywords

• poisoning
• carbon monoxide
• lactate
• hyperbaric oxygenation
• carboxyhemoglobin

Akut Karbon Monoksit Zehirlenmesiyle Başvuran Hastaların Laktat Düzeyinin Karboksihemoglobin ve Klinik Bulgularla İlişkisi

Abstract

Amaç: Akut karbon monoksit (carbon monoxide, CO) zehirlenmesi, ölümle sonuçlanan önemli ve önlenebilir bir zehirlenme nedenidir. Hafif zehirlenmelerde yorgunluk, baş ağrısı, bulantı ve kusma gibi spesifik olmayan belirtiler görülürken şiddetli maruziyetlerde bilinç kaybı, koma ve ölüm ortaya çıkabilir. Bu çalışmanın amacı, laktat ve karboksihemoglobin (carboxyhemoglobin, COHb) düzeylerinin akut CO zehirlenmesi olan hastaların klinik ve tedavi sürecindeki yerini araştırmaktır. Gereç ve Yöntemler: Veriler hastane otomasyon sistemi ve hasta dosyalarından, ICD-10 kodu “T58: Karbonmonoksitin Toksik Etkisi” olanlar seçilerek elde edildi. Hastaların başvuru sırasındaki kan parametreleri ve yaşamsal belirtileri, zehirlenme nedenleri, hastaneye geliş süreleri ve başvuru sırasındaki Glasgow koma skorları kayıt altına alınmıştır. Hastaların CO zehirlenmesine bağlı ve zehirlenme ile ilgili komplikasyonları ve aldıkları tedavi planı ve hastaneye yatış durumu ile ilgili verileri kaydedilmiştir. Bulgular: Nörolojik ve kardiyak komplikasyon görülen ve görülmeyen hastalar arasında CO ve laktat değerlerinde istatistiksel olarak anlamlı bir fark bulunmuştur (p<0,001). Ayrıca hiperbarik oksijen tedavisi alan ve almayan hastalar ile hastaneye yatışı olan ve olmayan hastalar arasında COHb ve laktat değerlerinde istatistiksel olarak anlamlı bir farklılık bulunmuştur (p<0,001). Biyokimyasal parametreler açısından bakıldığında, COHb ile pH, baz açığı, bikarbonat ve laktat düzeyleri arasında anlamlı korelasyon saptanmıştır. Sonuç: Bu çalışmada, acil servise başvuru anındaki COHb ve laktat değerlerinin, CO zehirlenmesi olan hastaların prognozu, klinik seyrinin takip edilmesi ve tedavi sürecinde önemli olduğu gösterilmiştir. Ayrıca, yüksek laktat ve COHb değerlerinin nörolojik ve kardiyak komplikasyon gözlenmesiyle de ilişkili olabileceği düşünülmektedir.

Keywords

• zehirlenmeler
• karbon monoksit
• laktat
• hiperbarik oksijen
• karboksihemoglobin

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