The true degree of hemic hypoxia in determining the severity of carbon monoxide poisoning: a clinical observation

V.I. Lysenko, M.A. Golyanischev, E.A. Karpenko, I.V. Karamushko

Abstract


Background. Poisoning with carbon monoxide is the most frequently detected intoxication by toxic gases. Previously, the authors found that the greatest number of carbon monoxide poisoning in 2015 occurred due to fires, in the second place — faulty ventilation systems. The purpose of the study is to improve the results of the carbon monoxide poisoning treatment by more accurate diagnosing of the severity. Materials and methods. The authors have analyzed clinical-anamnestic and laboratory data of six victims as a result of mass poisoning with carbon monoxide. By applying the indicator “effective oxyhemoglobin”, the severity of poisoning has been specified. The available literature on the topic has been reviewed and analyzed. In addition, the authors included data from the PubMed database. Results. The cause of carbon monoxide poisoning was improper operation of water heater. Consequently, seven people (one child hospitalized in a specialized hospital) were injured in this accident. We include the following significant clinical features: relative tachycardia was detected in all the affected; pathological changes on the ECG were in the victims with the most severe neurologic symptoms. Subsequently, based on the level of carboxyhemoglobinemia (at the time of admission to the hospital), the severity of clinically and anamnestically determined poisoning was underestimated by one degree. As a result of the search for such discrepancy explanation, based on the information on the increase in hemoglobin affinity for oxygen under conditions of carboxyhemoglobinemia, the authors proposed a calculated index — “effective oxyhemoglobin”. After the calculation, in all the victims, effective oxyhemoglobin was consistent with hemoglobin level in mild anaemia. Thus, the use of the effective oxyhemoglobin indicator has allowed to specify the severity of carbon monoxide poisoning detected in the laboratory that increased the validity of the clinical and anamnestic evaluation. Conclusions. An early assessment of the real degree of hemic hypoxia by means of an effective oxyhemoglobin index enables to increase the validity of the disease prognosis and to improve treatment outcomes in patients with carbon monoxide poisoning.

Keywords


carbon monoxide poisoning; carboxyhemoglobin; effective oxyhemoglobin; oxyhemoglobin dissociation; hypoxia

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DOI: https://doi.org/10.22141/2224-0586.6.85.2017.111611

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