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Deutsches Arzteblatt International Dec 2018The symptoms of carbon monoxide (CO) poisoning are nonspecific, ranging from dizziness and headache to unconsciousness and death. A German national guideline on the... (Review)
Review
BACKGROUND
The symptoms of carbon monoxide (CO) poisoning are nonspecific, ranging from dizziness and headache to unconsciousness and death. A German national guideline on the diagnosis and treatment of this condition is lacking at present.
METHODS
This review is based on a selective literature search in the PubMed and Cochrane databases, as well as on existing guidelines from abroad and expert recommendations on diagnosis and treatment.
RESULTS
The initiation of 100% oxygen breathing as early as possible is the most important treatment for carbon monoxide poisoning. In case of CO poisoning, the reduced oxygen-carrying capacity of the blood, impairment of the cellular respiratory chain, and immune-modulating processes can lead to tissue injury in the myocardium and brain even after lowering of the carboxyhemoglobin (COHb) concentration. In patients with severe carbon monoxide poisoning, an ECG should be obtained and biomarkers for cardiac ischemia should be measured. Hyperbaric oxygen therapy (HBOT) should be critically considered and initiated within six hours in patients with neurologic deficits, unconsciousness, cardiac ischemia, pregnancy, and/or a very high COHb concentration. At present, there is no general recommendation for HBOT, in view of the heterogeneous state of the evidence from multiple trials. Therapeutic decision-making is directed toward the avoidance of sequelae such as cognitive dysfunction and cardiac complications, and the reduction of mortality. Smoke intoxication must be considered in the differential diagnosis. The state of the evidence on the diagnosis and treatment of this condition is not entirely clear. Alternative or supplementary pharmacological treatments now exist only on an experimental basis.
CONCLUSION
High-quality, prospective, randomized trials that would enable a definitive judgment of the efficacy of HBOT are currently lacking.
Topics: Adult; Biomarkers; Carbon Monoxide Poisoning; Carboxyhemoglobin; Dizziness; Female; Headache; Humans; Hyperbaric Oxygenation; Male; Oxygen; Prospective Studies
PubMed: 30765023
DOI: 10.3238/arztebl.2018.0863 -
Journal of Veterinary Internal Medicine Jan 2023Endogenous production of carbon monoxide during hemoglobin metabolism leads to the formation of carboxyhemoglobin. Carboxyhemoglobin concentration is abnormally high in...
BACKGROUND
Endogenous production of carbon monoxide during hemoglobin metabolism leads to the formation of carboxyhemoglobin. Carboxyhemoglobin concentration is abnormally high in humans with hemolytic anemia (HA).
HYPOTHESIS
Measurement of carboxyhemoglobin concentration can discriminate HA from other forms of anemia.
ANIMALS
Twenty-seven dogs with HA (immune-mediated HA, n = 22; microangiopathic HA, n = 5), 27 dogs with non-HA (kidney disease, n = 14; immune-mediated thrombocytopenia, [n = 6]; miscellaneous, n = 7) and 24 nonanemic control dogs.
METHODS
Prospective cohort study. Carboxyhemoglobin quantification, a CBC and biochemistry profile were performed upon admission, and survival to hospital discharge and at 30 days were the measured outcomes. Groups were compared by the Mann-Whitney and Kruskal-Wallis tests. Receiver-operator characteristic (ROC) analyses were used to examine the predictive utility of carboxyhemoglobin for the diagnosis of HA in anemic dogs.
RESULTS
Carboxyhemoglobin (median [interquartile range]) differed between dogs with HA (7.7% [2.5%]) and non-HA (3.6% [1.05]; P < .001) and dogs with HA and nonanemic dogs (3.5% [0.65%]; P < .001). No difference was detected between nonHA and nonanemic dogs. The area under the ROC curve for carboxyhemoglobin as predictor of HA in anemic dogs was 0.997 (95% CI, 0.99-1.00). Three optimal cut-off points were identified, including 5.05%, 4.55% and 4.85%, with corresponding sensitivity/specificity of 92.6%/100%, 100%/92.6% and 96.3%/96.3%, respectively. Neither carboxyhemoglobin nor any of the CBC or chemistry analytes were associated with survival.
CONCLUSIONS AND CLINICAL IMPORTANCE
Carboxyhemoglobin proved an excellent predictor of HA in dogs and might constitute a useful, ancillary tool for diagnosing and monitoring hemolytic anemias.
Topics: Animals; Dogs; Humans; Anemia, Hemolytic; Biomarkers; Carboxyhemoglobin; Dog Diseases; Prognosis; Prospective Studies; Hemoglobins; Carbon Monoxide
PubMed: 36571460
DOI: 10.1111/jvim.16617 -
CMAJ : Canadian Medical Association... May 2014
Review
Topics: Accidents, Home; Carbon Monoxide Poisoning; Carboxyhemoglobin; Confined Spaces; Emergencies; Female; Fires; Humans; Hyperbaric Oxygenation; Male; Oxygen Inhalation Therapy; Prognosis; Risk Factors; Severity of Illness Index; Survival Rate; Treatment Outcome
PubMed: 24396094
DOI: 10.1503/cmaj.130972 -
Actas Espanolas de Psiquiatria Jan 2022arbon monoxide (CO) is an odorless, tasteless, colorless and nonirritating gas 1. In Spain, most of the accidents due to CO poisoning are caused by water heaters2,3,4....
arbon monoxide (CO) is an odorless, tasteless, colorless and nonirritating gas 1. In Spain, most of the accidents due to CO poisoning are caused by water heaters2,3,4. CO binds to hemoglobin with much greater affinity than oxygen, for- ming carboxyhemoglobin (COHb) and resulting in impaired oxygen transport and utilization.XS In up to 40 percent of patients with significant CO exposure, a delayed neuropsy- chiatric syndrome (DNS) can arise 3 to 240 days after appa- rent recovery, characterized by cognitive deficits, personality changes, movement disorders, and focal neurologic deficits, which may persist for a year or longer.
Topics: Carbon Monoxide Poisoning; Carboxyhemoglobin; Cognitive Dysfunction; Humans; Spain; Syndrome
PubMed: 35103300
DOI: No ID Found -
Academic Emergency Medicine : Official... Jul 1999
Topics: Carbon Monoxide Poisoning; Carboxyhemoglobin; Child; Humans; Toxicology
PubMed: 10433544
DOI: 10.1111/j.1553-2712.1999.tb00454.x -
BMJ Clinical Evidence Oct 2010Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood... (Review)
Review
INTRODUCTION
Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood samples and expressed as a percentage of carboxyhaemoglobin, or indirectly using the carbon monoxide in expired breath. Carboxyhaemoglobin percentage is the most frequently used biomarker of carbon monoxide exposure. Although the diagnosis of carbon monoxide poisoning can be confirmed by detecting elevated levels of carboxyhaemoglobin in the blood, the presence of clinical signs and symptoms after known exposure to carbon monoxide should not be ignored.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of oxygen treatments for acute carbon monoxide poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 100% hyperbaric oxygen, oxygen 28%, and oxygen 100% by non-re-breather mask.
Topics: Carbon Monoxide; Carbon Monoxide Poisoning; Carboxyhemoglobin; Humans; Oxygen; Respiration
PubMed: 21418677
DOI: No ID Found -
BMJ Clinical Evidence Jul 2008Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood... (Review)
Review
INTRODUCTION
Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood samples and expressed as a percentage of carboxyhaemoglobin, or indirectly using the carbon monoxide in expired breath. Carboxyhaemoglobin percentage is the most frequently used biomarker of carbon monoxide exposure. Although the diagnosis of carbon monoxide poisoning can be confirmed by detecting elevated levels of carboxyhaemoglobin in the blood, the presence of clinical signs and symptoms after known exposure to carbon monoxide should not be ignored.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of oxygen treatments for acute carbon monoxide poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 100% hyperbaric oxygen, oxygen 28%, and oxygen 100% by non-re-breather mask.
Topics: Carbon Monoxide; Carbon Monoxide Poisoning; Carboxyhemoglobin; Humans; Oxygen; Respiration
PubMed: 19445736
DOI: No ID Found -
BMC Emergency Medicine Jan 2021Carbon monoxide causes electrical, functional, and morphological changes in the heart. It is unclear, however, whether the indicators of myocardial damage can predict...
BACKGROUND
Carbon monoxide causes electrical, functional, and morphological changes in the heart. It is unclear, however, whether the indicators of myocardial damage can predict the patient's prognosis after carbon monoxide poisoning. This retrospective study aimed to investigate the relationship between the carboxyhemoglobin level and electrocardiographic (ECG) changes and whether the ECG changes and troponin I levels are related to the patient's prognosis after carbon monoxide poisoning.
METHODS
Carboxyhemoglobin, troponin I, and ECG parameters were measured in 70 patients with carbon monoxide poisoning. The QT and RR intervals were measured for each ECG lead in all patients, and the corrected QT interval and corrected QT dispersion were calculated.
RESULTS
The correlation between the maximum corrected QT interval and the carboxyhemoglobin level was significant (P = 0.0072, R = 0.1017), as were the relationships between QT dispersion and carboxyhemoglobin (P < 0.001, R = 0.2358) and the corrected QT dispersion and carboxyhemoglobin (P < 0.001, R = 0.2613). The multivariate logistic analysis showed that the significant predictors of sequential disability were corrected QT dispersion (P = 0.0042), and troponin I level (P = 0.0021).
CONCLUSIONS
Patients' prognosis following carbon monoxide poisoning can be predicted based on corrected QT dispersion and the troponin I level. Patients with myocardial damage should be monitored not only for their cardiovascular outcome but also for their neurological outcome and their prognosis.
Topics: Carbon Monoxide Poisoning; Carboxyhemoglobin; Electrocardiography; Humans; Retrospective Studies; Troponin I
PubMed: 33451295
DOI: 10.1186/s12873-021-00405-7 -
Anaesthesia Jan 1990
Topics: Aged; Blood Transfusion; Carboxyhemoglobin; Humans; Male
PubMed: 2316843
DOI: 10.1111/j.1365-2044.1990.tb14509.x -
Medicine and Science in Sports and... Oct 2018Peripheral capillary oxygen saturation (SpO2) is used as surrogate for arterial blood oxygen saturation. We studied the degree of discrepancy between SpO2 and arterial...
INTRODUCTION/PURPOSE
Peripheral capillary oxygen saturation (SpO2) is used as surrogate for arterial blood oxygen saturation. We studied the degree of discrepancy between SpO2 and arterial oxygen (SaO2) and identified parameters that may explain this difference.
METHODS
We included patients who underwent cardiopulmonary exercise testing at Cleveland Clinic. Pulse oximeters with forehead probes measured SpO2 and arterial blood gas samples provided the SaO2 both at rest and peak exercise.
RESULTS
We included 751 patients, 54 ± 16 yr old with 53% of female gender. Bland-Altman analysis revealed a bias of 3.8% with limits of agreement of 0.3% to 7.9% between SpO2 and SaO2 at rest. A total of 174 (23%) patients had SpO2 ≥ 5% of SaO2, and these individuals were older, current smokers with lower forced expiratory volume in the first second and higher partial pressure of carbon dioxide and carboxyhemoglobin. At peak exercise (n = 631), 75 (12%) SpO2 values were lower than the SaO2 determinations reflecting difficulties in the SpO2 measurement in some patients. The bias between SpO2 and SaO2 was 2.6% with limits of agreement between -2.9% and 8.1%. Values of SpO2 ≥ 5% of SaO2 (n = 78, 12%) were associated with the significant resting variables plus lower heart rate, oxygen consumption, and oxygen pulse. In multivariate analyses, carboxyhemoglobin remained significantly associated with the difference between SpO2 and SaO2 both at rest and peak exercise.
CONCLUSIONS
In the present study, pulse oximetry commonly overestimated the SaO2. Increased carboxyhemoglobin levels are independently associated with the difference between SpO2 and SaO2, a finding particularly relevant in smokers.
Topics: Adult; Aged; Carbon Dioxide; Carboxyhemoglobin; Exercise Test; Female; Humans; Male; Middle Aged; Oximetry; Oxygen; Oxygen Consumption; Pulmonary Gas Exchange; Smokers
PubMed: 29771822
DOI: 10.1249/MSS.0000000000001658