Analysis of patients presenting to the emergency department with carbon monoxide intoxication

Selim Yurtseven; Abdullah Arslan; Umut Eryigit; Mucahit Gunaydin; Ozgur Tatli; Faruk Ozsahin; Yunus Karaca; Nurhak Aksut; Ali Aygun; Abdulkadir Gunduz

doi:10.1016/j.tjem.2015.05.001

Selim Yurtseven¹, Abdullah Arslan², Umut Eryigit³, Mucahit Gunaydin¹, Ozgur Tatli¹, Faruk Ozsahin¹, Yunus Karaca⁴, Nurhak Aksut⁵, Ali Aygun⁴, Abdulkadir Gunduz⁴

¹Kanuni Training and Research Hospital, Department of Emergency Medicine, Trabzon, Turkey
²Kanuni Training and Research Hospital, Department of Undersea and Hyperbaric Medicine, Trabzon, Turkey
³Diyarbakır Selahaddin Eyyubi State Hospital, Department of Emergency Medicine, Diyarbakır, Turkey
⁴Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
⁵Manisa State Hospital, Department of Emergency Medicine, Manisa, Turkey

Keywords: Carbon monoxide intoxication; Hyperbaric oxygen; Troponin I; Echocardiography

Abstract

Objectives: Carbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT) is of proven efficacy in the treatment of CO intoxication.

The purpose of this study was to describe the general characteristics of carbon monoxide (CO) intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT) in these patients.

Material and methods: Patients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively.

Results: One hundred seventy-one patients were included; 140 (81.9%) were poisoned by stoves, 18 (10.5%) by hot water boilers and 10 in (5.8%) by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5%) of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%). One patient died after 15 session of HBOT.

Conclusion: Although elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT.