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)

Intoxicación por monóxido de carbono: estudio observacional de pacientes que acudieron a Urgencias durante 2020 / Carbon monoxide poisoning: an observational study of patients admitted to Emergency Department during 2020

El objetivo fue describir las intoxicaciones monóxido de carbono. Se diseñó un corte transversal que incluyó una muestra consecutiva de mediciones de carboxihemoglobina (COHb), realizadas Enero y Diciembre 2020 en la Central de Emergencias del Hospital Italiano de Buenos Aires. Se utilizaron bases secundarias y revisión manual de historias clínicas para recolección de varia-bles de interés. Durante el período de estudio hubo 20 pacientes confirmados, con media de 50 años (DE 20), 55% sexo masculino, 20% tabaquistas, y una única embarazada. El 70% correspondieron al trimestre Junio-Julio-Agosto. La fuente de intoxicación más frecuente se debió a accidentes domésticos (calefón, estufa, brasero, hornalla, salamandra) que representaron el 50% de los casos, 30% por incendios, y el 20% restante explicado por tabaco o factor desconocido. Los estudios de laboratorio más solicitados fueron: 95% recuento de glóbulos blancos, 85% glucemia, 70% CPK, y 55% troponina. Los hallazgos relevantes fueron COHb con mediana de 7.15%, CPK con mediana de 89 U/mL, y troponina con mediana de 8.5 pg/mL. La totalidad se realizó electrocardiograma: 15% presentaron arritmia como hallazgo patológico, y ninguno isquemia. En cuanto la presentación clínica: 30% presentó cefalea, 15% síncope, 15% coma, 10% mareos y 10% convulsiones. Sólo 25% tuvieron tomografía y 15% resonancia de cerebro, sin hallazgos críticos. Sin embargo, 15% fueron derivados para trata-miento con cámara hiperbárica. La mayoría ocurrieron en invierno y explicados por accidentes domésticos. Será necesario un fortalecimiento del rol preventivo que apunte al control de la instalación y el buen funcionamiento de artefactos, como mantener los ambientes bien ventilados (AU)

The objective was to describe carbon monoxide poisoning. A cross sectional was designed, which included a consecutive sample of carboxyhemoglobin (COHb) measurements, carried from January to December 2020 at the Emergency Department of tHospital Italiano de Buenos Aires. Secondary databases and manual review of medical records were used to collect variables of interest. During the study period there were 20 confirmed patients, with a mean age of 50 (SD 20), mostly male (55%), 20% smokers, and only one pregnant woman, 70% corresponded to June-July-August. The most frequent source of poisoning was explained to domestic accidents (water heater, stove, brazier, stove, salamander) which represented 50% of cases, 30% due to fires, and the remaining 20% by tobacco or unknown factor. The most laboratory studies were: 95% white blood cell count, 85% glycemia, 70% CPK, and 55% troponin. Meanwhile, relevant findings were carboxyhemoglobin with a median of 7.15%, CPK with a median of 89 U/mL, and troponin with a median of 8.5 pg/mL. All underwent an electrocardiogram: 15% presented arrhythmia as a pathological finding, and none ischemia. Regarding the clinical presentation: 30% presented headache, 15% syncope, 15% coma, 10% dizziness and 10% seizures. Only 25% had brain tomography and 15% MRI, without pathological findings. However, 15% were referred for treatment with a hyperbaric chamber. Most of the cases occurred in winter and explained by domestic accidents. It will be necessary to strengthen the preventive role that aims to control the installation and the proper functioning of devices, such as keeping rooms well ventilated (AU)

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Risk of late appearance of acute myocardial infartion after carbon monoxide (CO) intoxication / Riesgo de aparición de infarto agudo de miocardio en el largo plazo después de una intoxicación por monóxido de carbono (CO)

ABSTRACT Background: After acute carbon monoxide intoxication, there may be a higher risk for late adverse cardiac events. However, these patients are usually not followed to monitor the appearance of these effects. Aim: To follow patients seen at an emergency department for carbon monoxide intoxication, monitoring the appearance of myocardial infarction. To assess the predictive value for such complication of serum troponin, carboxyhemoglobin, and procalcitonin levels at the moment of intoxication. Material and Methods: We followed 237 patients receiving emergency care for carbon monoxide intoxication, with a serum carboxyhemoglobin of 5% or more, between 2010 and 2012. Levels of procalcitonin and troponin I were measured. Patients were followed for five years after the intoxication. Results: During the follow up period, 35 patients had a myocardial infarction. These patients had significantly higher carboxyhemoglobin, procalcitonin and troponin I levels at the moment of the intoxication than their counterparts who did not had a myocardial infarction in the follow up. A logistic regression analysis showed that age, carboxyhemoglobin levels, procalcitonin, troponin 1 and length of CO exposure were associated with a higher risk of myocardial infarction. Procalcitonin, troponin and carboxyhemoglobin levels had a high sensitivity and specificity to predict the appearance of myocardial infarction, with high areas under the receiver operating characteristic (ROC) curves. Conclusions: In patients with CO intoxication, carboxyhemoglobin, troponin and procalcitonin levels at the moment of the intoxication are significant predictors of the late appearance of myocardial infarction.

Antecedentes: Después de una intoxicación con monóxido de carbono, hay un mayor riesgo de desarrollar problemas cardiovasculares a largo plazo. Sin embargo, estos pacientes no son seguidos habitualmente para evaluar la aparición de estos eventos. Objetivo: Efectuar un seguimiento de pacientes que han sufrido una intoxicación con CO, evaluando la aparición de infarto del miocardio. Evaluar el valor de los niveles de troponina, carboxihemoglobina y procalcitonina para predecir la aparición de estos eventos. Material y Métodos: Seguimos 237 pacientes que fueron atendidos de urgencia por una intoxicación con CO, con niveles de carboxihemoglobina de 5% o más, entre 2010 y 2012. Se midieron los niveles de procalcitonina, troponina 1 y carboxihemoglobina y los pacientes fueron seguidos por cinco años después de la intoxicación. Resultados: Durante el seguimiento, 35 pacientes tuvieron un infarto al miocardio. Estos pacientes tenían niveles significativamente más altos de procalcitonina, troponina 1 y carboxihemoglobina al momento de la intoxicación, que los pacientes que no tuvieron un infarto durante el seguimiento. Una regresión logística mostró que la edad, carboxihemoglobina, procalcitonina, troponina y la duración de exposición a CO se asociaron a un mayor riesgo de infarto. Procalcitonina, troponina 1 y carboxihemoglobina tuvieron una alta sensibilidad y especificidad para predecir la aparición de infarto, con áreas bajo la curva ROC (receiver operating characteristic) elevadas. Conclusiones: En pacientes con intoxicación por CO, la carboxihemoglobina, procalcitonina y troponina son predictores significativos de la aparición de infarto agudo de miocardio en el largo plazo.

Impact of environmental pollution on carboxyhemoglobin levels among smoking and non-smoking motorcycle taxi drivers / Impacto da poluição ambiental no nível de carboxihemoglobina entre mototaxistas tabagistas e não tabagistas

Studies related to environmental pollution, carbon monoxide levels and smoking need to be deepened, especially in the case of traffic workers. Therefore, the objective was to verify the association between environmental carbon monoxide and carboxyhemoglobin levels among smoking and non-smoking motorcycle taxi drivers. A longitudinal epidemiological study was carried out with 95 motorcycle taxi drivers with measurement of the environmental carbon monoxide, carboxyhemoglobin in the exhaled air in three moments with interval of six months, between June 2014 and March 2015, as well as sociodemographic and occupational characteristics of these workers. The seasons of the year presented different carbon monoxide averages (p <0.05), with higher levels in the spring and lower in the autumn, while carboxyhemoglobin levels among smokers and non-smokers were high in the winter, fair in the spring and low in the autumn. Statistical differences were observed between subgroups: between autumn and spring for nonsmokers (p = 0.024) and between winter and autumn for smokers (p = 0.042). There was a positive correlation between carbon monoxide and carboxyhemoglobin levels for non-smokers (rs = 0.9983; p < 0.01). Environmental pollution represented different levels in the four seasons of the year and significant association with carboxyhemoglobin levels.Thecarboxyhemoglobin levels were higher among smokers, with statistical significance between winter and fall seasons, while non-smokers presented normal levels, whatconfirms the direct influence of tobacco in carboxyhemoglobin levels.

Os estudos relacionados à poluição ambiental, níveis de monóxido de carbono e o tabagismo, necessitam de aprofundamento, com destaque para os trabalhadores do trânsito. Para tanto, verificar associação entre níveis de monóxido de carbono ambiental e carboxihemoglobina em mototaxistas tabagistas e não tabagistas. Estudo epidemiológico, longitudinal, realizado com 95 mototaxistas com mensuração do monóxido de carbono ambiental, carboxihemoglobina no ar exalado em três momentos com intervalo de seis meses, entre junho de 2014 e março de 2015, assim como as características sociodemográficas e ocupacionais desses trabalhadores. As estações do ano apresentaram diferentes médias de monóxido de carbono (p<0,05), com níveis maiores na primavera e menores no outono, enquanto os níveis de carboxihemoglobina entre tabagistas e não tabagistas apresentaram-se elevados no inverno, intermediário na primavera e baixos no outono. Observou-se diferença estatística entre subgrupos, no outono e na primavera para os não tabagitas (p=0,024) e entre o inverno e outono para os tabagistas (p=0,042). Houve correlação positiva entre os níveis de monóxido de carbono e carboxihemoglobina para não fumantes (rs=0,9983; p<0,01). A poluição ambiental representou diferentes níveis nas quatro estações do ano e associação significativa com os níveis de carboxihemoglobina. Os níveis de carboxihemoglobina mostraram-se mais elevados nos tabagistas, com significância estatística entre a estação inverno e a do outono, enquanto os não tabagistas apresentaram níveis normais, o que reforça a participação direta do tabaco nos níveis de carboxihemoglobina.

Is hyperbaric oxygen therapy more effective than normobaric oxygen therapy for improving acute neuropsychologic status due to carbon monoxide poisoning?

OBJECTIVE: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. METHODS: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH < 7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. RESULTS: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. CONCLUSION: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.

Inter-alpha Inhibitor H4 as a Potential Biomarker Predicting the Treatment Outcomes in Patients with Hepatocellular Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Early prediction of treatment outcomes represents an essential step towards increased treatment efficacy and survival in patients with hepatocellular carcinoma (HCC). In this study, we performed two-dimensional electrophoresis (2-DE) followed by protein profiling to identify biomarkers predictive of therapeutic outcomes in patients with HCC who received liver-directed therapy (LDTx) involving local radiotherapy (RT), and studied the underlying mechanisms of the identified proteins. MATERIALS AND METHODS: 2-DE analysis was conducted by pooling sera from patients with a good or poor prognosis; serum proteomic profiles of the two groups were compared and analyzed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Identified proteins were confirmed via enzyme-linked immunosorbent assay. An invasion assay was performed after overexpression and knockdown of target protein in Huh7 cells. RESULTS: Levels of inter-alpha inhibitor H4 (ITIH4), fibrinogen gamma chain, keratin 9/1 complex, carbonic anhydrase I, and carbonmonoxyhemoglobin S were changed by more than 4-fold in response to LDTx. In particular, pre-LDTx ITIH4 expression was more than 5-fold higher in patients with a good prognosis, compared to patients with a poor prognosis. The migration ability of Huh7 cells was significantly suppressed and enhanced by ITIH4 overexpression and knockdown, respectively. The tumors of patients with HCC and a good prognosis expressed high levels of ITIH4, compared to those of patients with a poor prognosis. CONCLUSION: Taken together, ITIH4 may be a potential therapeutic target that could inhibit cancer metastasis, as well as a prognostic marker for patients with HCC who are receiving LDTx.

The biomass charcoal with reduced carbon monoxide emission decreases mortality after the biomass charcoal burning in mice

OBJECTIVE: This study examined the effects on mortality and cell death after biomass charcoal combustion, in which carbon monoxide (CO) emissions were reduced using a biomass combustion improver in mice. METHODS: The biomass (glycerin) charcoal (Biomass CharCoal by Pusan National University, BCCP) was generated in the Power Generation System laboratory, Pusan National University. The effects and molecular mechanisms of biomass charcoal in carbon monoxide poisoning were examined by analyzing the mouse mortality, circulating leukocytes, carboxyhemoglobin (COHb), and expression of the inflammation-related genes, and cleaved capase-3 using enzyme-linked-immunosorbent-assays, real-time polymerase chain reaction, or Western blotting. RESULTS: The mortality rates were lower in the BCCP-exposed mice than in the raw charcoal-exposed mice. The circulating leukocytes were lower in the BCCP-exposed mice than in the raw charcoal-exposed mice. On the other hand, there was no significantly difference in the levels of COHb between both mice. Interestingly, the expression of the apoptosis-related gene, cleaved-capase 3, and the inflammation and tissue necrosis-related gene and receptor for the advanced glycation end products were reduced markedly in the BCCP-exposed mice compared to the raw charcoal-exposed mice. Decreased inflammation and tissue necrotic factors could be molecular mechanisms for the decreased mortality rates after BCCP burning. CONCLUSION: Biomass charcoal (BCCP) reduced the mortality rates and inflammation and tissue necrotic factors by 30%–40%. These results suggest that the biomass charcoal (BCCP) could reduce the incidence of suicide and CO-associated delayed symptoms after charcoal burning. Furthermore, it could extend the time for rescue in suicide attempts using charcoal burning.

Intoxicacion por monoxido de carbono / Carbon monoxide poisoning

Resumen:La intoxicación por monóxido de carbono o "asesino silente" es la intoxicación mortal más común, encontrándose en fuentes de exposición muy comunes como automóviles, tabaquismo y combustión de gases o combustibles.La principal característica nociva aguda del gas se basa en su alta afinidad por la hemoglobina, mientras que los efectos crónicos se basan en su interacción con otras proteínas. Ante la clínica inespecífica del cuadro, se debe tener un alto grado de sospecha diagnóstica, para iniciar el tratamiento adecuado o oxigenoterapia normobárica o hiperbárica según corresponda.

Abstract:Carbon monoxide poisoning or "silent killer" is the most common fatal poisoning, found in very common sources of exposure such as cars, smoking and gas or fuel combustion. The main acute harmful characteristic of gas is based on its high affinity for hemoglobin, while the chronic effects are based on its interaction with other proteins.Before the nonspecific clinic of the table, must have a high degree of diagnostic suspicion, to start the appropriate treatment or normobaric or hyperbaric oxygen therapy as appropriate.

What is the Clinical Significance of Initial Lactate Measurement Compared to Carboxyhemoglobin Measurement in Carbon Monoxide Poisoning?

PURPOSE: This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning. METHODS: We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels. RESULTS: Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001). CONCLUSION: Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.

Variáveis ambientais e níveis de monóxido de carbono exalado e carboxihemoglobina em idosos praticantes de exercício / Environmental variables and levels of exhaled carbon monoxide and carboxyhemoglobin in elderly people taking exercise

Resumo O objetivo deste artigo é analisar o monóxido de carbono exalado, a carboxihemoglobina e as variáveis cardiopulmonares em idosos praticantes de exercícios em ambientes externos e correlacionar com clima e poluição. Estudo ecológico temporal com 118 idosos ativos em Cuiabá. Foram obtidas informações sobre uso de medicamentos, tabagismo, antropometria, espirometria, peak-flow, saturação de oxigênio, frequência cardíaca, monóxido de carbono exalado, carboxihemoglobina, além de dados climáticos, queimadas e poluição. Temperatura ambiental, umidade relativa do ar e queimadas correlacionaram com monóxido de carbono exalado e carboxihemoglobina (p < 0,05). Frequência cardíaca correlacionou com alterações de temperatura ambiental, tempo de exposição solar e umidade relativa (p < 0,05). Idosos sofrem influências ambientais alterando níveis de monóxido de carbono, carboxihemoglobina e frequência cardíaca, sendo necessário monitoramento destes durante os exercícios, sugerindo-se o uso do monoxímetro para avaliação de exposição a poluentes.

Abstract This article aims to analyze levels of exhaled carbon monoxide, carboxyhemoglobinand cardiopulmonary variables in old people practicing exercise in external environments, and correlate them with climate and pollution factors. Temporal ecological study with118 active elderly people in the city of Cuiabá, in the state of Mato Grosso, Brazil. Data were obtained on use of medication, smoking, anthropometric measurements, spirometry, peak flow, oxygen saturation, heart rate, exhaled carbon monoxide, carboxyhemoglobin, climate, number of farm fires and pollution. Correlations were found between on the one hand environmental temperature, relative humidity of the air and number of farmers’ fires, and on the other hand levels of carbon monoxide exhaled and carboxyhemoglobin (p < 0.05).There was a correlation between heart rate and changes in environmental temperature, time of exposure to the sun and relative humidity (p < 0.05). In elderly people, environmental factors influence levels of exhaled carbon monoxide, carboxyhemoglobin and heart rate. There is thus a need for these to be monitored during exercise. The use of a carbon monoxide monitor to evaluate exposure to pollutants is suggested.

Risk Factors Associated with Rhabdomyolysis in Acute Carbon Monoxide Poisoning

PURPOSE: The aim of this study was to determine the risk factors for rhabdomyolysis in patients with carbon monoxide (CO) poisoning. METHODS: This was a retrospective study on patients with CO poisoning who visited the emergency department from January 1, 2014 to December 31, 2015. We compared clinical variables between patients with and without rhabdomyolysis. RESULTS: Among 120 patients who were included to this study, 108 patients exhibited normal value of CPK (creatine phosphokinase), and 12 patients were diagnosed as rhabdomyolysis. Sources of CO, duration of CO exposure, initial GCS (Grasgow coma scale), initial systolic and diastolic blood pressure, initial body temperature and AKI (Acute kidney injury) were showed significant difference between patients who developed rhabdomyolysis and patients who did not. In addition, initial white blood cell counts, troponin I level and carboxyhemoglobin (COHb) level were more higher in rhabdomyolysis group. pH and initial bicarbonate level were more lower. Duration of CO exposure (Odds ratio, 1.011; 95% confidence interval, 1.002∼1.020, P=0.021)was found to be only risk factor for rhabdomyolysis by logistic regression analysis. CONCLUSION: Duration of CO exposure is potential risk factor of rhabdomyolysis development in CO poisoning.

Changes of HbCO in the Blood of Rats with Different CO Concentration and Inhalation Time / 法医学杂志

OBJECTIVES@#To explore the change rules of behavioral characteristics, survival time and saturation of carboxyhemoglobin （HbCO） in different CO concentration to provide experimental basis for the cases of CO poisoning death in forensic practice.@*METHODS@#Total 160 SD rats were randomly divided into four groups. CO with the concentration of 1 250 mg/m³, 3 750 mg/m³, 6 250 mg/m³ were continuously and respectively replenished in a self-made toxicant exposure equipment until rats died from poisoning. In different CO concentration, the behavioral characteristics and survival time of poisoning rats were observed and recorded. The saturation of HbCO in heart blood was detected by spectrophotometric method. Organs such as brain, heart, lung and liver, and heart blood were obtained via autopsy and histopathological observation was performed.@*RESULTS@#The behavioral characteristics of CO poisoning rats were limp and slow response. There were a gradual decrease of survival time and an increase of HbCO saturation in rats with the increase of CO concentration. Three rats in CO concentration of 1 250 mg/m³ group showed lower saturations of HbCO than the lethal dose and this situation hasn't been found in other groups.@*CONCLUSIONS@#The animal model of CO poisoning established under different CO concentration has the advantages such as simplicity and good repeatability, which lays a foundation to the further study for CO and other inhaled toxic gas in the research of forensic sciences.

Serum bilirubin value predicts hospital admission in carbon monoxide-poisoned patients. Active player or simple bystander?

OBJECTIVES:Although carbon monoxide poisoning is a major medical emergency, the armamentarium of recognized prognostic biomarkers displays unsatisfactory diagnostic performance for predicting cumulative endpoints.METHODS:We performed a retrospective and observational study to identify all patients admitted for carbon monoxide poisoning during a 2-year period. Complete demographical and clinical information, along with the laboratory data regarding arterial carboxyhemoglobin, hemoglobin, blood lactate and total serum bilirubin, was retrieved.RESULTS:The study population consisted of 38 poisoned patients (23 females and 15 males; mean age 39±21 years). Compared with discharged subjects, hospitalized patients displayed significantly higher values for blood lactate and total serum bilirubin, whereas arterial carboxyhemoglobin and hemoglobin did not differ. In a univariate analysis, hospitalization was significantly associated with blood lactate and total serum bilirubin, but not with age, sex, hemoglobin or carboxyhemoglobin. The diagnostic performance obtained after combining the blood lactate and total serum bilirubin results (area under the curve, 0.90; 95% CI, 0.81-0.99; p<0.001) was better than that obtained for either parameter alone.CONCLUSION:Although it remains unclear whether total serum bilirubin acts as an active player or a bystander, we conclude that the systematic assessment of bilirubin may, alongside lactate levels, provide useful information for clinical decision making regarding carbon monoxide poisoning.

Cerebrovascular ischaemia after carbon monoxide intoxication

Carbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.

Idiopathic erythrocytosis in a patient on chronic hemodialysis

A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7-31.5 mIU/mL), carboxyhemoglobin level was 0.6% (range, 0-1.5%), and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.

A Case of Rhabdomyolysis Presenting with Acute Kidney Injury Complicating Carbon Monoxide Poisoning / 대한내과학회지

Carbon monoxide (CO) poisoning has increased rapidly in South Korea and may cause a variety of clinical effects. The most common complications are neurologic and neuropsychological disturbances. However, in rare cases, CO poisoning may also be associated with acute kidney injury and non-traumatic rhabdomyolysis. Here, we report a case of acute kidney injury and rhabdomyolysis complicating CO poisoning. A 32-year-old woman was admitted to our emergency department with dyspnea and confused consciousness after exposure to CO during a suicide attempt involving charcoal briquettes. Laboratory findings revealed a carboxyhemoglobin (COHb) level of 44.8%, a blood urea nitrogen level of 20.5 mg/dL, a serum creatinine level of 1.4 mg/dL, and a creatine phosphokinase level of 8,688.3 IU/L. Acute kidney injury and rhabdomyolysis complicating CO poisoning were diagnosed. This case was managed with normobaric oxygen therapy and hydration. The patient recovered completely with respect to renal function and muscle enzyme level, and COHb level returned to 0%.

Carbon monoxide poisoning-induced cardiomyopathy from charcoal at a barbecue restaurant: a case report

OBJECTIVE: Acute carbon monoxide poisoning has important clinical value because it can cause severe adverse cardiovascular effects and sudden death. Acute carbon monoxide poisoning due to charcoal is well reported worldwide, and increased use of charcoal in the restaurant industry raises concern for an increase in occupational health problems. We present a case of carbon monoxide poisoning induced cardiomyopathy in a 47-year-old restaurant worker. MATERIALS AND METHODS: A male patient was brought to the emergency department to syncope and complained of left chest pain. Cardiac angiography and electrocardiography were performed to rule out acute ischemic heart disease, and cardiac markers were checked. After relief of the symptoms and stabilization of the cardiac markers, the patient was discharged without any complications. RESULTS: Electrocardiography was normal, but cardiac angiography showed up to a 40% midsegmental stenosis of the right coronary artery with thrombotic plaque. The level of cardiac markers was elevated at least 5 to 10 times higher than the normal value, and the carboxyhemoglobin concentration was 35% measured at one hour after syncope. Following the diagnosis of acute carbon monoxide poisoning induced cardiomyopathy, the patient's medical history and work exposure history were examined. He was found to have been exposed to burning charcoal constantly during his work hours. CONCLUSIONS: Severe exposure to carbon monoxide was evident in the patient because of high carboxyhemoglobin concentration and highly elevated cardiac enzymes. We concluded that this exposure led to subsequent cardiac injury. He was diagnosed with acute carbon monoxide poisoning-induced cardiomyopathy due to an unsafe working environment. According to the results, the risk of exposure to noxious chemicals such as carbon monoxide by workers in the food service industry is potentially high, and workers in this sector should be educated and monitored by the occupational health service to prevent adverse effects.

A Case of Dyadic Death Associated with Helium Gas: An Autopsy Case Report / 대한법의학회지

A 39-year-old man, his 35-year-old wife, and their 13-year-old daughter were found dead in their home. The man and his daughter were found lying in her bedroom, with his head wrapped in a plastic bag connected to four helium gas cylinders by green polypropylene tubes. Fragments of the burnt ignition briquette were found in the bucket located at her feet. His wife was found in a decomposed state lying on her right side in her bedroom. Autopsy findings for the man were unremarkable except for cherry pink lividity; the blood carboxyhemoglobin concentration was 73%. Autopsy findings were unremarkable for the woman as well, except for a few petechial hemorrhages and conjunctival congestion. The daughter showed no definite abnormalities; however, her blood and lung contained helium gas. The deceased man's suicide note, evidence gathered at the scene, and postmortem examination revealed that this was a case of dyadic death.

Relation between workplace accidents and the levels of carboxyhemoglobin in motorcycle taxi drivers / Associacao entre acidentes de trabalho e os niveis de carboxi-hemoglobina em trabalhadores mototaxistas / Asociacion entre accidentes de trabajo y los niveles de carboxihemoglobina en trabajadores moto-taxistas

OBJECTIVE: to investigate the relation between workplace accidents and the levels of carboxyhemoglobin found in motorcycle taxi drivers. METHOD: correlational, quantitative study involving 111 workers and data obtained in July 2012 through a questionnaire to characterize the participants and blood collection to measure carboxyhemoglobin levels. RESULT: 28.8% had suffered workplace accidents; 27.6% had fractured the lower limbs and significant symptoms of carbon monoxide exposure were verified in smokers. The carboxyhemoglobin levels were higher among smokers and victims of workplace accidents. CONCLUSION: motorcycle taxi drivers had increased levels of carboxyhemoglobin, possibly due to the exposure to carbon monoxide; these levels are also increased among smokers and victims of workplace accidents. The study provides advances in the knowledge about occupational health and environmental science, and also shows that carboxyhemoglobin can be an indicator of exposure to environmental pollutants for those working outdoors, which can be related to workplace accidents. .

OBJETIVO: verificar a associação entre acidentes de trabalho e os níveis de carboxi-hemoglobina apresentados por trabalhadores mototaxistas. MÉTODO: estudo correlacional, quantitativo, com 111 trabalhadores e dados obtidos em julho de 2012, por meio de questionário de caracterização dos sujeitos e coleta sanguínea para dosagem de carboxi-hemoglobina. RESULTADO: 28,8% sofreram acidentes de trabalho, 27,6% apresentaram fraturas em membros inferiores e constatou-se significância de sintomas de exposição ao monóxido de carbono entre fumantes. Os níveis de carboxi-hemoglobina apresentaram-se superiores entre fumantes e acidentados do trabalho. CONCLUSÃO: mototaxistas apresentam níveis de carboxi-hemoglobina aumentados, possivelmente pela exposição ao monóxido de carbono; esses níveis também aumentam entre os fumantes e acidentados do trabalho. O estudo propicia avanços do conhecimento em relação às temáticas da saúde do trabalhador e ciências ambientais, e indica que a carboxi-hemoglobina pode ser um indicador de exposição aos poluentes ambientais para quem trabalha a céu aberto e estar relacionada a acidente de trabalho. .

OBJETIVO: verificar la asociación entre accidentes de trabajo y los niveles de carboxihemoglobina presentados por trabajadores moto-taxistas. MÉTODO: estudio de correlación, cuantitativo, con 111 trabajadores y datos recolectados en julio del 2012 mediante cuestionario de caracterización de los sujetos y recolecta sanguínea para dosificación de carboxihemoglobina. RESULTADO: el 28,8% sufrió accidentes de trabajo; 27,6% presentó fracturas en miembros inferiores y se constató significancia de síntomas de exposición al monóxido de carbono entre fumantes. Los niveles de carboxihemoglobina se revelaron superiores entre fumantes y accidentados de trabajo. CONCLUSIÓN: moto-taxistas muestran niveles de carboxihemoglobina aumentados, posiblemente debido a la exposición al monóxido de carbono; estos niveles también aumentan entre los fumantes y accidentados de trabajo. El estudio propicia avances del conocimiento con relación a la temáticas de la salud ocupacional y ciencias ambientales e indica que la carboxihemoglobina puede ser un indicador de exposición a los contaminantes ambientales para quien trabaja a cielo abierto y está relacionada a accidente de trabajo. .