Yıl 2020, Cilt 12 , Sayı 3, Sayfalar 443 - 450 2020-10-20

Akut Karbonmonoksit Zehirlenmesi olan Hastalarının Klinik ve Manyetik Rezonans Görüntüleme Bulguları
Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Nezih KAVAK [1] , Burcu DOĞAN [2] , Hasan SULTANOĞLU [3] , Rasime Pelin KAVAK [4] , Meltem ÖZDEMİR [5]


Amaç: Bu çalışmada akut karbon monoksit (CO) zehirlenmesi tanısı konulan hastaların demografik ve klinik özellikleri ile Glasgow Koma Skoru (GKS) 15’in altında olan hastaların manyetik rezonans görüntüleme (MRG)’de tespit edilen serebral lezyonları tanımlamayı amaçladık.

Yöntem: 327 hasta yaş, cinsiyet, CO zehirlenme nedenleri, klinik belirtileri, nörolojik bulguları, GKS’ları, karboksihemoglobin (COHb), serum pH, laktat, kreatin kinaz (CK), kreatini kinaz, miyokardiyal band (CK-MB), troponin-I düzeyleri ile beyin MRG bulguları ve mortalite durumları açısından retrospektif olarak değerlendirildi.

Bulgular: Çalışmamızda hastaların yaş ortancası 31.5 yıl (IQR=19.5 yıl) olup, hastaların %72.2’si kadındı. Hastaların 34 (%10.4)’ünde nörolojik bulgular saptandı Nörolojik bulgusu olan hastaların dispne sıklığı anlamlı olarak yüksekti (p<0,05). Çalışmamızda nörolojik bulgusu olan hastaların COHb düzeyi ve laktat düzeyi anlamlı olarak yüksek, pH düzeyi anlamlı olarak düşük saptandı (p<0,05). Nörolojik bulgu varlığının CK, CK-MB ve troponin-I düzeyi arasında anlamlı bir ilişki saptanmadı (p>0,05). Nörolojik bulgusu olan hastaların, takip süresi anlamlı olarak uzun olduğu, daha sıklıkla hiperbarik oksijen tedavisi aldığı saptandı (p<0,05). Çalışmamızda olguların yatış oranı % 10.7, mortalite oranı % 0,9 olarak saptandı. Nörolojik bulgusu olan hastalarda yatış ve mortalite oranları anlamlı olarak yüksek saptandı (p<0,05). MRG çekilen 32 olgunun 13’ünde (%40.6) patolojik bulgulara rastlandı.

Sonuç: Akut karbonmonoksit zehirlenmelerinin akut beyin hasarına yol açabileceği, klinik bulgu veren bu hastalarda akut dönemde çekilen MRG’sinde %40 oranında bulgu vereceği saptandı.

Objective: We aim to evaluate the demographic and clinical characteristics of patients with acute carbon monoxide (CO) poisoning, who had a Glasgow Coma Score (GCS) below 15, and who had cerebral lesions detected in magnetic resonance imaging (MRI).

Method: The age, gender, causes of CO intoxication, clinical signs, neurological findings, GCS, blood carboxyhemoglobin level (COHb), serum pH, lactate, creatine kinase (CK), creatinine kinase-myocardial band MB (CK-MB), troponin-I level, brain MRI findings, treatment, and mortality status of 327 patients were evaluated retrospectively.

Results: The median age of patients was 31.5 years (IQR=19.5 years), 72.2% of the patients were women. Neurological findings were detected in 34 (10.4%) of the patients. The frequency of dyspnea was significantly higher in patients with neurological findings (p<0.05). The COHb and lactate levels of patients with neurological findings were found to be significantly high, the pH level was significantly lower (p<0.05). There was no significant relationship between the presence of neurological findings and CK, CK-MB, and troponin-I levels (p>0.05). Patients with neurological findings were found to have a significantly longer follow-up period, more frequently received hyperbaric oxygen therapy (p<0.05). The rate of hospitalization was 10.7%, the mortality rate was 0.9%. Hospitalization and mortality rates were significantly high in patients with neurological findings (p <0.05). Pathological findings were detected in 13 (40.6%) of 32 of patients who had an MRI.

Conclusion: It was determined that acute CO poisoning may lead to acute brain damage, 40% would be detected in brain MRIs taken in patients during the acute phase.

  • 1. Yildiz MN, Eroglu SE, Ozen C, Yildiz HA, Sektioglu BK, Alkan C. Analysis of the effects of COHb, lactate, and troponin levels on the clinical process and outcome in patients who were admitted to the emergency service due to carbon monoxide poisoning. North Clin Istanb. 2019;3(2):141–5. doi: 10.14744/nci.2018.88709.
  • 2. Lo C-P, Chen S-Y, Lee K-W, Chen W-L, Chen C-Y, Hsueh C-J, et al. Brain injury after acute carbon monoxide poisoning: early and late complications. AJR Am J Roentgenol. 2007;189(4):W205-11. doi: 10.2214/AJR.07.2425.
  • 3. Mukhopadhyay S, Hirsch A, Etienne S, Melnikova N, Wu J, Sircar K, Orr M. Surveillance of carbon monoxide-related incidents - Implications for prevention of related illnesses and injuries, 2005-2014. Am J Emerg Med. 2018;36(10):1837-44. doi: 10.1016/j.ajem.2018.02.011.
  • 4. Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, 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.
  • 5. Kim H, Choi S, Park E, Yoon E, Min Y, Lampotang S. Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6. Clin Exp Emerg Med. 2018;5(3):185-191. doi:10.15441/ceem.17.217.
  • 6. Chang YC, Lee HY, Huang JL, Chiu CH, Chen CL, Wu CT. Risk Factors and Outcome Analysis in Children with Carbon Monoxide Poisoning. Pediatr Neonatol. 2017;58(2):171-7. doi: 10.1016/j.pedneo.2016.03.007.
  • 7. Kim YJ, Sohn CH, Seo DW, Oh BJ, Lim KS, Kim WY. Clinical predictors of acute brain injury in carbon monoxide poisoning patients with altered mental status at admission to emergency department. Acad Emerg Med. 2019;26(1):60-7. doi: 10.1111/acem.13510.
  • 8. Jeon S-B, Sohn CH, Seo D-W, Oh BJ, Lim KS, Kang D-W, et al. Acute brain lesions on magnetic resonance imaging and delayed neurological sequelae in carbon monoxide poisoning. JAMA Neurol. 2018;75(4):436-43. doi: 10.1001/jamaneurol.2017.4618.
  • 9. Bleecker ML. Carbon monoxide intoxication. Chapter 12 In: Handb Clin Neurol. 131: Elsevier; 2015;131: 191-203. doi: 10.1016/B978-0-444-62627-1.00024-X.
  • 10. Pepe G, Castelli M, Nazerian P, Vanni S, Del Panta M, Gambassi F, et al. Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study. Scand J Trauma Resusc Emerg Med. 2011;19:16. doi: 10.1186/1757-7241-19-16.
  • 11. Thom SR, Taber RL, Mendiguren, II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med. 1995;25(4):474-80. doi: 10.1016/s0196-0644(95)70261-x.
  • 12. Kim Y, Cha Y, Kim M, Kim H, Lee Y, Youk H, et al. The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning. Hum Exp Toxicol. 2018;37(6):587-95. doi: 10.1177/0960327117722821.
  • 13. O'donnell P, Buxton P, Pitkin A, Jarvis LJ. The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning. Clin Radiol. 2000;55(4):273-80. doi: 10.1053/crad.1999.0369.
  • 14. Kaya H, Coskun A, Beton O, Kurt R, Yildirim M, Gul I. A cost effective parameter for predicting the troponin elevation in patients with carbon monoxide poisoning: red cell distribution width. Eur Rev Med Pharmacol Sci. 2016;20(13):2891-8.
  • 15. Stearns D, Sircar K. National unintentional carbon monoxide poisoning estimates using hospitalization and emergency department data. Am. J. Emerg. 2019;37(3):421-6. doi: 10.1016/j.ajem.2018.06.002.
  • 16. Hassan, OA, Abdelaleem, SA, Hamdy, L. A prospective comparative study between three chemical markers for predicting delayed neurological sequelae in patients with acute carbon monoxide poisoning of poison control center in Minia University Hospital. Ain-Shams J Forensic Med Clin Toxicol 2018; 31: 23–32. doi: 10.21608/AJFM.2018.15874.
  • 17. Genç S, Aygün D. Karbonmonoksit Zehirlenmesinde Karboksihemoglobin Düzeyi, Zehirlenmenin Şiddeti ve Mini Mental Durum Testi Skalası Arasındaki İlişki. Turk J Emerg Med. 2013;13(1): 25-32. doi: 10.5505/1304.7361.2013.36002.
  • 18. Sohn CH, Huh JW, Seo DW, Oh BJ, Lim KS, Kim WY. Aspiration pneumonia in carbon monoxide poisoning patients with loss of consciousness: prevalence, outcomes, and risk factors. Am J Med. 2017;130(12):1465. e21-. e26. doi: 10.1016/j.amjmed.2017.06.038.
  • 19. Sokal JA, Kralkowska E. The relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man. Archives of toxicology. 1985;57(3):196-9. doi: 10.1007/bf00290887.
  • 20. Keles A, Demircan A, Kurtoglu G. Carbon monoxide poisoning: how many patients do we miss?. Eur J Emerg Med. 2008;15(3):154-7. doi: 10.1097/MEJ.0b013e3282efd519.
  • 21. Besli GE, Ergüven M, Karadogan M, Yilmaz Ö. Carbon Monoxide Poisoning in Children. Eurasian J Emerg Med 2010;9:26–30. doi: 10.4170/JAEM.2009.19480.
  • 22. 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. doi: 10.1007/s00134-003-1866-0.
  • 23. Chu K, Jung K-H, Kim H-J, Jeong S-W, Kang D-W, Roh J-K. Diffusion-weighted MRI and 99mTc-HMPAO SPECT in delayed relapsing type of carbon monoxide poisoning: evidence of delayed cytotoxic edema. Eur Neurol. 2004;51(2):98-103. doi: 10.1159/000076536.
  • 24. Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med. 1995;25(4):474-80. doi: 10.1016/s0196-0644(95)70261-x.
  • 25. Ducassé JL, Celsis P, Marc-Vergnes JP. Non-comatose patients with acute carbon monoxide poisoning: hyperbaric or normobaric oxygenation?. Undersea Hyperb Med. 1995, 22(1):9-15.
  • 26. Moon RE, DeLong E. Hyperbaric oxygen for carbon monoxide poisoning. Med J Aust. 1999 Mar 1;170(5):197-9.
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Orcid: 0000-0003-2751-0046
Yazar: Nezih KAVAK (Sorumlu Yazar)
Kurum: University of Health Sciences Dışkapi Yıldırım Beyazıt Training and Research Hospital, Emergency Department, Ankara, Turkey.
Ülke: Turkey


Orcid: 0000-0003-1379-7832
Yazar: Burcu DOĞAN
Kurum: Hitit University Erol Olcok Training and Research Hospital, Emergency Department, Çorum, Turkey.
Ülke: Turkey


Orcid: 0000-0003-4099-572X
Yazar: Hasan SULTANOĞLU
Kurum: Düzce University Medical Faculty, Emergency Department, Düzce, Turkey.
Ülke: Turkey


Orcid: 0000-0001-9782-0029
Yazar: Rasime Pelin KAVAK
Kurum: University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radiology Department, Ankara, Turkey.
Ülke: Turkey


Orcid: 0000-0002-7388-2871
Yazar: Meltem ÖZDEMİR
Kurum: University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radiology Department, Ankara, Turkey.
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 20 Ekim 2020

Bibtex @araştırma makalesi { ktd735274, journal = {Konuralp Medical Journal}, issn = {1309-3878}, eissn = {1309-3878}, address = {}, publisher = {Düzce Üniversitesi}, year = {2020}, volume = {12}, pages = {443 - 450}, doi = {10.18521/ktd.735274}, title = {Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning}, key = {cite}, author = {Kavak, Nezih and Doğan, Burcu and Sultanoğlu, Hasan and Kavak, Rasime Pelin and Özdemir, Meltem} }
APA Kavak, N , Doğan, B , Sultanoğlu, H , Kavak, R , Özdemir, M . (2020). Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning . Konuralp Medical Journal , 12 (3) , 443-450 . DOI: 10.18521/ktd.735274
MLA Kavak, N , Doğan, B , Sultanoğlu, H , Kavak, R , Özdemir, M . "Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning" . Konuralp Medical Journal 12 (2020 ): 443-450 <https://dergipark.org.tr/tr/pub/ktd/issue/57326/735274>
Chicago Kavak, N , Doğan, B , Sultanoğlu, H , Kavak, R , Özdemir, M . "Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning". Konuralp Medical Journal 12 (2020 ): 443-450
RIS TY - JOUR T1 - Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning AU - Nezih Kavak , Burcu Doğan , Hasan Sultanoğlu , Rasime Pelin Kavak , Meltem Özdemir Y1 - 2020 PY - 2020 N1 - doi: 10.18521/ktd.735274 DO - 10.18521/ktd.735274 T2 - Konuralp Medical Journal JF - Journal JO - JOR SP - 443 EP - 450 VL - 12 IS - 3 SN - 1309-3878-1309-3878 M3 - doi: 10.18521/ktd.735274 UR - https://doi.org/10.18521/ktd.735274 Y2 - 2020 ER -
EndNote %0 Konuralp Tıp Dergisi Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning %A Nezih Kavak , Burcu Doğan , Hasan Sultanoğlu , Rasime Pelin Kavak , Meltem Özdemir %T Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning %D 2020 %J Konuralp Medical Journal %P 1309-3878-1309-3878 %V 12 %N 3 %R doi: 10.18521/ktd.735274 %U 10.18521/ktd.735274
ISNAD Kavak, Nezih , Doğan, Burcu , Sultanoğlu, Hasan , Kavak, Rasime Pelin , Özdemir, Meltem . "Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning". Konuralp Medical Journal 12 / 3 (Ekim 2020): 443-450 . https://doi.org/10.18521/ktd.735274
AMA Kavak N , Doğan B , Sultanoğlu H , Kavak R , Özdemir M . Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning. Konuralp Medical Journal. 2020; 12(3): 443-450.
Vancouver Kavak N , Doğan B , Sultanoğlu H , Kavak R , Özdemir M . Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning. Konuralp Medical Journal. 2020; 12(3): 443-450.
IEEE N. Kavak , B. Doğan , H. Sultanoğlu , R. Kavak ve M. Özdemir , "Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning", Konuralp Medical Journal, c. 12, sayı. 3, ss. 443-450, Eki. 2020, doi:10.18521/ktd.735274