Aspectos por considerar en autopsias por intoxicación aguda con monóxido de carbono, el asesino silente. A propósito de dos casos / Aspects to consider in autopsies for acute carbon monoxide poisoning, the silent killer. About two cases

El monóxido de carbono (CO) es un gas que se produce durante la combustión incompleta de diferentes materiales orgánicos. Una vez que se inhala, se absorbe hacia la sangre, ejerciendo su efecto a nivel sistémico. Se une fuertemente a la hemoglobina, y forma la carboxihemoglobina lo que provoca una disminución del transporte de oxígeno a los tejidos y dependiendo de su concentración puede ser mortal. Los hallazgos comúnmente encontrados en la autopsia son color rojo cereza en la piel y órganos, así como edema pulmonar, entre otros. El diagnóstico de intoxicación por CO se basa en la medición post mortem de carboxihemoglobina en sangre, por lo que se deben tomar muestras para cuantificar estos niveles. Con respecto al manejo en estos casos, se presenta dos casos correspondientes a la autopsia médica legal en las que se estableció como causa de muerte la intoxicación por monóxido de carbono.

Carbon monoxide (CO) is a gas that is produced during the incomplete combustion of different organic materials. Once inhaled, it is absorbed into the blood, exerting its effect at the systemic level. It strongly binds to hemoglobin, and forms carboxyhemoglobin, which causes a decrease in oxygen transport to the tissues and, depending on its concentration, can be fatal. The findings commonly found in the autopsy are cherry red color in the skin and organs, as well as pulmonary edema, among others. The diagnosis of CO poisoning is based on the postmortem measurement of carboxyhemoglobin in the blood, so samples must be taken to quantify these levels. Regarding the handling of these cases, two cases corresponding to the legal medical autopsy are presented in which carbon monoxide poisoning was established as the cause of death.

El rol del laboratorio en los hallazgos de intoxicación y exposición a monóxido de carbono / The role of the laboratory in findings of carbon monoxide poisoning and exposure

El monóxido de carbono es un gas altamente tóxico que se origina principalmente por la combustión incompleta de combustibles fósiles. La intoxicación presenta síntomas inespecíficos que solapan otras patologías y por lo tanto es indispensable la confirmación mediante la medición de la carboxihemoglobina en sangre. El laboratorio incorporó la determinación en el informe del estado ácido base a partir de octubre del 2018, debido a que previamente el médico debía solicitarla frente a la sospecha de una intoxicación. El objetivo del trabajo fue evaluar si esta medida implementada por el laboratorio contribuyó a mejorar el diagnóstico de intoxicación por CO, analizar las características de los pacientes con COHb mayor o igual a 5% y definir un valor de reporte inmediato para la COHb. El 46% de los casos con COHb mayor o igual a 5% no se relacionaban con una intoxicación y/o exposición a CO. De los casos de intoxicación se encontró que el 77% fueron diagnosticados a partir de la sospecha médica y un 23% por hallazgo del laboratorio. Se concluyó que es de mucha utilidad el rol del laboratorio en detectar aquellos casos que no fueron evidentes clínicamente. Existen ciertas patologías como las oncológicas o la enfermedad de Wilson donde se vieron valores elevados de COHb sin presentar intoxicación y se definió finalmente, como valor de reporte inmediato 7% para la COHb. (AU)

Carbon monoxide is a highly toxic gas that originates mainly from incomplete combustion of fossil fuels. Intoxication causes nonspecific symptoms that overlap with other conditions and, therefore, confirmation by measuring blood carboxyhemoglobin is essential. The laboratory incorporated the measurement in the acid-base status report as of October 2018, as it was previously required to be requested by the physician in case of suspected intoxication. The aim of this study was to evaluate whether this measure implemented by the laboratory contributed to the improvement of the diagnosis of CO intoxication, to analyze the characteristics of patients with COHb greater than or equal to 5% and to define an immediate reporting value for COHb. Overall, 46% of the cases with COHb greater than or equal to 5% were not related to CO poisoning and/or exposure. Of the cases of intoxication, 77% were diagnosed based on medical suspicion and 23% on laboratory findings. It was concluded that the laboratory has a useful role in detecting cases that were not clinically evident. There are certain diseases including different types of cancer or Wilson's disease where elevated COHb values were seen without intoxication and finally, 7% for COHb was defined as the immediate reporting value (AU)

Clinical significance of bispectral index monitoring in patients with acute severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To analyze the correlation of bispectral index (BIS) with the prognosis of patients with acute severe carbon monoxide poisoning (ASCMP) and its predictive value of adverse outcomes. Methods: In March 2021, 106 ASCMP patients who were treated in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to December 2020 were taken as research objects. All patients underwent 24-hour BIS monitoring after admission, and were divided into good prognosis group (n=75) and poor prognosis group (n=31) according to the prognosis of the patients' cranial nerve function after 60 d. The general conditions, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Glasgow Coma Scale (GCS) score at admission and 24-hour BIS mean were compared between the two groups. Pearson correlation analysis was used to analyze the correlations between the 24-hour BIS mean and GCS score at admission, APACHEⅡ score and coma time. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of 24-hour BIS mean, GCS score at admission, APACHEⅡ score and coma time on adverse outcome of ASCMP patients. Results: The coma time and APACHEⅡ score of the patients in the poor prognosis group were significantly higher than those in the good prognosis group, the GCS score at admission and 24-hour BIS mean were significantly lower than those in the good prognosis group (P<0.05) . Pearson correlation analysis showed that the 24-hour BIS mean was positively correlated with the GCS score at admission, and negatively correlated with the APACHEⅡ score, coma time (r=0.675, -0.700, -0.565, P<0.001) . The 24-hour BIS mean had the highest predictive value for adverse outcome of ASCMP patients, with a cut-off value of 74, the area under the curve was 0.883 (95%CI: 0.814-0.951, P<0.001) , and the sensitivity and specificity were 73.3% and 87.1%, respectively. Conclusion: The 24-hour BIS mean has a good correlation with the acute brain nerve injury, the severity of the disease and coma time of patients with ASCMP. And it has a high predictive value for the adverse outcome in patients with ASCMP.

Intoxicación aguda con monóxido de carbono (ICO) secundaria a pipa de agua (Narguile). Reporte de un caso / Carbon monoxide poisoning caused by water pipe smoking (Narghile). A case report

Resumen Dentro de las formas alternativas de consumo de tabaco, se describe el uso de pipas de agua (también llamadas hookah, shisha o narguile) como implementos de uso. Esta forma de uso es una forma emergente en nuestro medio, con uso en estudiantes universitarios y secundarios. Debido a que utiliza carbón para quemar el tabaco, junto a largos períodos de uso, presenta riesgo de intoxicación por monóxido de carbono, especialmente si se utiliza en ambientes cerrados. En este artículo presentamos el caso de una paciente femenina de 19 años, quién fue traída al hospital con una intoxicación grave por monóxi do de carbono secundaria a uso de pipa de agua, requiriendo tratamiento con oxígeno en cámara hiperbárica. Realizamos una revisión de la bibliografía.

Abstract Amongst the alternative ways of tobacco use, water pipes (also called hookah, shisha or narghile) have been used as implements. This type of use is an emergent one in our environment, being used by high school and college students. Due to the use of charcoal as a way to burn the tobacco, and the long using times it presents, the users are at risk of being poisoned by carbon monoxide, especially if they smoke in enclosed spaces. In this paper, we present the case of a 19-year-old female patient, who was brought to the hospital with a severe case of carbon monoxide poisoning, requiring treatment with oxygen in a hyperbaric chamber. We make a review of the literature.

Intoxicación por monóxido de carbono / Carbon monoxide poisoning

Introducción: A nivel mundial, existe un incremento de las intoxicaciones por monóxido de carbono recibidas en los servicios de urgencia. En Cuba no es frecuente este tipo de intoxicación y existe desconocimiento para su diagnóstico precoz. El monóxido de carbono es un gas inodoro, incoloro, no irritante a las mucosas y altamente tóxico para el hombre. Es un contaminante de la atmósfera terrestre y el agente causal más frecuente de la intoxicación por gases. Objetivo: Describir la intoxicación por monóxido de carbono en un paciente atendido en el Hospital Militar;Dr. Mario Muñoz Monroy de Matanzas, Cuba. Caso clínico: Paciente masculino de 19 años de edad que inhala en un área cerrada, de forma accidental, los gases de la combustión de un vehículo durante 30 minutos. Permaneció en el lugar de la exposición sin medios de protección individual por un período de tres horas y comenzó con síntomas correspondientes a una intoxicación moderada por monóxido de carbono. Ingresó en la sala de cuidados intermedios para tratamiento. Conclusiones: El paciente tuvo una evolución favorable, tratado con oxígeno normobárico e hiperbárico(AU)

Introduction: Worldwide, there is an increase in poisonings by carbon monoxide received in emergency services. In Cuba this type of intoxication is not frequent and there is ignorance for its early diagnosis. Carbon monoxide is an odorless, colorless gas, not irritating to mucous membranes and highly toxic to man. It is a pollutant of the Earth's atmosphere and the most frequent causative agent of gas poisoning. Objective: To describe carbon monoxide poisoning in a patient treated at the Military Hospital Dr. Mario Muñoz Monroy from Matanzas, Cuba. Clinical case: A 19-year-old male patient inhaled in a closed area, accidentally, the combustion gases of a vehicle for 30 minutes. He remained in the place of exposure without means of individual protection for a period of three hours and began with symptoms corresponding to moderate intoxication by carbon monoxide. He was admitted at intermediate care ward for treatment. Conclusions: The patient had a favorable evolution, treated with normobaric and hyperbaric oxygen(AU)

Intoxicación por monóxido de carbono. Presentación de un caso / Carbon monoxide intoxication. Case presentation

RESUMEN Este caso se corresponde con un paciente de 19 años, masculino, que durante su trabajo en una construcción soterrada inhaló de forma accidental los gases de la combustión del vehículo con que trabajaba. Está acción se prolongó por aproximadamente 30 min y luego permaneció en el lugar durante 3 h sin medios de protección individual. Esto trajo como resultados la aparición de síntomas correspondientes a una intoxicación moderada por monóxido de carbono, por tal motivo fue ingresado en una institución hospitalaria para recibir tratamiento (AU).

ABSTRACT This is the case of a male patient, aged 19 years, who accidentally inhaled the combustion gases of the vehicle he worked with during his work in an underground construction. This action lasted for around 30 minutes, and after that he stayed in the place for three hours without individual protection devices. It resulted in the onset of symptoms of moderated carbon monoxide intoxication. That was the motivation of admitting him in the hospital for treatment (AU).

Intoxicación masiva con monóxido de carbono: puesta al día a partir de un caso / Massive poisoning with carbon monoxide: an update from a case

El monóxido de carbono es conocido como " el asesino silencioso" por tratarse de un gas incoloro e inodoro. De acuerdo con estas características, su toxicidad pasa desapercibida, lo cual dificulta arribar al diagnóstico. En la mayoría de los casos, las épocas frías y la intoxicación grupal hacen sospechar su presencia, debido a que se utilizan formas inapropiadas de calefacción tanto en el ámbito domiciliario como público. Nuestro objetivo es dar a conocer una intoxicación masiva con monóxido de carbono en un salón de fiestas infantiles en el que se utilizó una fuente de combustión instalada, no con el fin de calefaccionar, sino como abastecimiento de luz (grupo electrógeno). Se recalca que también puede ocurrir en cualquier época del año.

Carbon monoxide is known as the " silent murderer" because it is a colorless and odorless gas. According to these characteristics, toxicity goes unnoticed which makes the diagnosis difficult. In most cases, the cold periods and group poisoning make suspect its presence because inappropriate heat both in home or public environments. Our goal is to inform about a mass carbon monoxide poisoning in a children's parties room using a combustion source installed, not for the purpose of heating, but as a supply of light (generator), emphasizing that it can occur in any time of the year.

Smoke inhalation injury during enclosed-space fires: an update / Lesao por inalacao de fumaca em ambientes fechados: uma atualizacao

In view of the tragic fire at a nightclub in the city of Santa Maria, Brazil, which culminated in the sudden death of 232 young people, we decided to review the literature regarding smoke inhalation injury caused by enclosed-space fires, which can be divided into direct thermal damage, carbon monoxide poisoning, and cyanide poisoning. Such injuries often call for immediate orotracheal intubation, either due to acute airway obstruction or due to a reduced level of consciousness. The diagnosis and the severity of the thermal injury can be determined by fiberoptic bronchoscopy. The levels of gases and gas by-products in the bloodstream should be assessed as rapidly as possible, even while still at the scene of the incident. First responders can also treat carbon monoxide poisoning, with immediate administration of oxygen at 100%, as well as cyanide poisoning, with oxygen therapy and hydroxocobalamin injection.

Aproveita-se o trágico incêndio ocorrido em uma boate na cidade de Santa Maria, RS, que culminou na morte imediata de 232 jovens, para revisarmos a literatura com relação à lesão por inalação de fumaça em ambientes fechados, que pode ser dividida em dano térmico direito, intoxicação por monóxido de carbono e intoxicação por cianeto. Essas condições frequentemente levam à necessidade de intubação orotraqueal imediata, seja por obstrução aguda de vias aéreas, seja por depressão do nível de consciência. O diagnóstico e a gravidade da injúria térmica podem ser determinados pela fibrobroncoscopia. Quanto aos envenenamentos, a dosagem dos gases ou de seus subprodutos na corrente sanguínea é possível e deve ser realizada ainda na cena do incidente. Da mesma maneira, o tratamento da intoxicação por monóxido de carbono consiste na administração imediata de oxigênio a 100%, enquanto o da intoxicação por cianeto consiste em oxigenoterapia e hidroxicobalamina injetável como antídoto. .

Revisión de intoxicación por monóxido de carbono / Revision of carbon monoxide intoxication

El monóxido de carbono es un gas muy peligroso que pasa desapercibido en el ambiente. Puede producir cefalea, náuseas, taquicardia, debilidad, convulsines, coma y muerte. El diagnóstico se basa en una historia compatible y el examen físico, en conjunción con el laboratorio. La intervención más importante en el manejo de la intoxicación por el monóxido de carbono es alejar al paciente de la fuente de monóxido de carbono y la terapia con oxígeno, para salvar la vida y prevenir las secuelas

Carbon monoxide is a very dangerous gas that pass unaware in the environment. It can produce headache, nausea, tachycardia, malaise, seizures, coma and death. The diagnosis is based upon a compatible history and physical examination in conjunction with the laboratory. The most important interventions in the management of carbon monoxide poisoning are removal from the source of carbon monoxide and oxygen therapy, to save the life and to prevent secuelae

Misdiagnosis of carbon monoxide intoxication in a patient with known coronary artery disease: a case report and review of cardiovascular effects of carbon monoxide poisoning / Mal diagnóstico de intoxicación por monóxido de carbono en un paciente diagnosticado con enfermedad de la arteria coronaria: reporte de un caso y estudio de los efectos cardiovasculares del envenenamiento por monóxido de carbono

This is a report of a patient who had documented coronary artery disease and was admitted with chest pain, nausea, vomiting and headache. She was immediately taken to coronary angiography and underwent percutaneous coronary intervention with stent implantation. After the operation, she was coincidentally diagnosed to have Carbon Monoxide (CO) poisoning. We discuss if percutaneous intervention (PCI) was an overtreatment and briefly review the mechanisms of the cardiovascular effects of CO toxicity which is an insidious pathology and diagnosed only if it is suspected.

Este es un reporte de una paciente con enfermedad de la arteria coronaria documentada, quien fuera ingresado con dolor de pecho, náuseas, vómitos y dolor de cabeza. A la paciente se le hizo inmediatamente una angiografía coronaria y se le realizó una intervención coronaria percutánea con implantación de stent. Después de la operación, se le diagnosticó por coincidencia envenenamiento por monóxido de carbono (CO). Analizamos si la intervención percutánea (IPC) fue un sobretratamiento y examinamos brevemente los mecanismos de los efectos cardiovasculares de la toxicidad por CO que puede ser insidiosa y diangosticada sólo si se tiene sospecha.

Carbon monoxide toxicity with neurological and cardiac complications

A family suffered carbon monoxide toxicity, with cerebral and / or cardiac complications, while sleeping in the cabin on a recreational boat. This article describes a couple exposed to a malfunctioning air-conditioning system on the boat, which subsequently developed the unique combination of cerebral symptoms and a non Q/non-ST elevation myocardial infarction, with enzyme elevations and electrocardiographic abnormalities. This interesting complication of a myocardial infarction secondary to carbon monoxide toxicity, associated with neurological manifestations, is reviewed.

Series clínicas de Medicina de Urgencia: intoxicación por monóxido de carbono, el gran simulador / Clinical series of emergency medicine: carbon monoxide poisoning, the great simulator

El monóxido de carbono (CO) es un gas incoloro, inodoro e insípido que se produce durante la combustión incompleta de materiales orgánicos que contienen carbono. La intoxicación por este gas es una causa frecuente de muerte por intoxicación involuntaria durante el período de otoño-invierno. El cuadro clínico suele ser inespecífico, simulando cuadros banales como las virosis hasta episodios graves con compromiso neurológico y alteración de conciencia. El diagnóstico exige al clínico conocer los factores de riesgo epidemiológicos y las distintas variedades de presentación clínica. Se presenta el caso clínico de una paciente que consulta por segunda vez en el Servicio de Urgencia por compromiso de conciencia transitorio, con un estudio inicial negativo. El antecedente anamnéstico de una mascota con síntomas similares permitió buscar probables fuentes de monóxido de carbono en su hogar, confirmándose el diagnóstico por niveles de carboxihemoglobina elevados. El diagnóstico de esta intoxicación suele estar basado en la sospecha clínica considerando los antecedentes epidemiológicos, el cuadro clínico y los factores de riesgo del caso individual.

A study on the effect of methanal during determination of carbon monoxide in blood / 法医学杂志

OBJECTIVE@#To confirm whether formaldehyde disturb detecting carbon monoxide in blood. To give an evidence that can be used for detecting carboxyhemoglobin more accurately in carbon monoxide posioning appraises.@*METHODS@#Blood samples came from carbon monoxide poisoning and the health were collected. Regular methods for detecting carboxyhemoglobin were used. Observing and comparing the detection results between which were spiked with methanal and no spiked one were performed.@*RESULTS@#Methanal will affect the result of following experiments such as heating, adding NaOH, absorbed by PdCl2 and spectrophotometry.@*CONCLUSION@#The samples which contaminated by formaldehyde couldn't be used for detecting carboxyhemoglobin.

Some usual and unusual poisonings due to carbon monoxide

Carbon monoxide poisoning is a frequent occurrence in both developed and under developed countries of the world. Carbon monoxide can be produced in fires, automobile engine exhausts and the incomplete combustion of organic matter. It is a [quot ]silent killer[quot ] that initially produces a mild progressive frontal headache, drowsiness and sleep that is usually ignored as common place. Continued low-level CO exposure for a long period of time in a confined space is cumulative and these accidental deaths are frequent but should be avoidable. Several usual and unusual poisonings are reported to illustrate its various forms of exposure. It all began many years ago when a bolt of lightening hit a fallen tree and produced a fire. Early cave man later learned to enjoy some of the benefits of this new discovery. They could now see at night, they could keep warm, keep the predators at bay, cook their food and make it taste better and be more gentle to their teeth. Also meat could be preserved and eaten at a later date especially if it were dried and smoked. They learned by trial and error that it was dangerous to bring their fire deep into their cave without a chimney. Carbon monoxide (CO) also can be easily produced by many other sources besides fire. Very common today is the incomplete combustion of gasoline in the engine of an automobile which can produce about 6 carbon monoxide

Factors affecting the determination of the percent carboxyhemoglobin saturation of blood / 法医学杂志

OBJECTIVE@#To investigate factors affecting the determination of the percent carboxyhemoglobin saturation (HbCO%) of blood in an attempt to offer further data for results interpretation and sample storage requirement.@*METHODS@#The HbCO% of blood samples stored in various conditions were detected by three spectrophotometries during the succeeding 30 days.@*RESULTS@#The data detected by reductive double-wavelength spectrophotometry and double-wavelength spectrophotometry were more stable than mono-wavelength spectrophotometry. The HbCO% of blood was significantly related with the storage conditions which include temperature, time and the degree of exposure to air.@*CONCLUSION@#Determinations of HbCO% are reliable which performed by reductive double-wavelength spectrophotometry and double-wavelength spectrophotometry, combine with spectral scans. During 30 days, blood stored at 4 degrees C exposed to a limited volume of air does not influence the determination of HbCO%.

Aspectos neuropsiquiátricos e neuropsicológicos da intoxicaçäo por monóxido de carbono / Neuropsychiatric and neuropsychological aspects of carbon monoxide intoxication

A intoxicaçäo por monóxido de carbono é modo frequente de tentativas de suicídio e também ocorre em incêndios ou devido a acidentes inesperados com equipamentos em fábricas, aquecedores de uso domésticos, boilers. Essa é uma revisäo dos aspectos clínicos, neuropsicológicos e de neuroimagem no envenenamento por CO. Em ambientes de emergência o quadro clínico pode passar desapercebido num primeiro momento em que o atendimento imediato é de grande importância para a evoluçäo de caso, devido aos sintomas inespecíficos decorrentes da intoxicaçäo. A longo prazo a intoxicaçäo por CO pode gerar quadros de sequela com especial repercussäo sobre o comportamento, a cogniçäo e a psicomotricidade. Há uma bateria desenvolvida especificamente para a avaliaçäo neuropsicológica nas fases agudas (a CONSB) enquanto nos quadros mais crônicos é essencial a avaliaçäo mais extensa para aquilatar as alteraçöes cognitivas mais definitivas. As correlaçöes clínicas e de neuroimagem apontam para maior gravidade nos quadros com lesäo em substância branca e núcleo pálido, áreas de menos vascularizaçäo e onde o efeito do CO parece ter mais potencial patológico. A TC, a RM e o SPECT säo complementares nos dados que proporcionam para a avaliaçäo da intensidade e localizaçäo das lesöes

Hipoacusia neurosensorial reversible por intoxicación con monóxido de carbono / Reversible neurosensorial hearing loss of intoxication with carbon monoxide

Se presenta el caso de una paciente de 35 años que sufrió una intoxicación crónica por monóxido de carbono (CO), con una sobreexposición final de tipo agudo, por lo cual requirió un tratamiento médico de urgencia y que desarrolló un compromiso otológico bilateral fundamentalmente neurosensorial, de tipo reversible y con compromiso principalmente de los tonos agudos. La intoxicación por CO, es una patología que rara vez se relaciona con alteraciones a nivel del oído. Las intoxicaciones agudas, que son las más frecuentemente diagnosticadas debido a lo evidente y dramático de su sintomatología, no presentan daño coclear presuntamente por el corto tiempo de exposición al CO. Distinto es el caso de la intoxicación de tipo crónica, en la cual la sintomatología es tan inespecífica y solapada que no se sospecha su presencia, unido a las características del gas el cual es inodoro, incoloro e insípido y no irritativo, por lo que ingresa en grandes cantidades al organismo por las vías respiratorias sin que la persona se percate de ello. Por este motivo generalmente es subdiagnosticada. Los estudios realizados en ratas, cobayos y las experiencias de intoxicaciones en humanos han demostrado que produce alteraciones cocleares reversibles