Acute cardiac effects of carbon monoxide poisoning in children

Tekşam, Özlem; Gümüş, Pınar; Bayrakçı, Benan; İlkay, Erdoğan; Kale, Gülsev

doi:10.1097/mej.0b013e328320ad48

Cited by 44 publications

(42 citation statements)

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“…In our study, the level of COHb was found to be above 30% in the patients who presented with loss of consciousness and seizure. The mean GCS score was found to be 13.8±2.5 in the study performed by Kandiş et al (9) reported that patients with hypotension have more severe clinical signs and lower GCS score (6). GCS was found to be <14 in 4.6% of the patients in our study group.…”

Section: Discussionmentioning

confidence: 53%

“…Children become symptomatic earlier in CO poisoning, since they have less blood volume, faster basal metabolism and higher tissue oxygen requirement and they are more sensitive to the toxic effects of CO (6). Clinically, CO poisoning can present with a wide spectrum of manifestations ranging from mild compliants to fainting, seizure and coma.…”

Section: Discussionmentioning

confidence: 99%

“…Oxydative stress directly causes to tissue damage and leads to occurence of signs (4). Children show manifestations early in carbonmonoxide poisoning, since they have less blood volume, faster basal metabolism and higher oxygen requirement in tissues and are more sensitive to the toxic effects of CO (6).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children

Boztepe¹,

Yalaki²,

Bilge³

2015

Turk Arch Ped

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Aim: The aim of our study was to investigate the relation of blood carboxyhemoglobin level with presentation finding and clinical properties and to demonstrate neurological and cardiological findings which are indicators of tissue hypoxia in patients followed up because of carbonmonoxide (CO) poisoning. Material and Methods:Three hundred and twenty-five patients who were followed up because of carbonmonoxide poisoning between 2011 and 2013 in our pediatric emergency department were evaluated prospectively. Ethics committee approval was obtained for the study on 10.19.2011 (number: 0437). The carbonmonoxide levels, source of intoxication, neurological and cardiological findings and treatment methods were recorded. Blood gases and cardiac enzymes were studied and electrocardiography (ECG) was performed. The data were analysed using SPSS for windows 16.0 package program. Results:One hundred and sixty-eight (51.7%) of the patients were female and the median age was 9 years (11 days-17 years). Two hundred and twenty-eight (70.2%) of the patients were poisoned while using heater and 78.1% presented during winter months. The median carbonmonoxide level of the patients was found to be 24.8%. Cardiac enzymes were found to be increased in 10.5% of the patients, first degree A-V block was found in 0.6% and negative T wave was found in 0.3%. Glasgow coma score was found to be below 14 in 4.6% of the patients. A significant correlation was found between the carboxyhemoglobin levels and neurological findings, cardiological findings and lactate (p<0.05). Normobaric oxygen treatment was given to 76.3% of the patients and hyperbaric oxygen treatment was given to 23.7%. Conclusions:We think that neurological disorders and cardiac findings may be closely related, since systemic involvement may be easier in carbonmonoxide poisoning in children, Glasgow coma score should be assessed in the follow-up of the patients and cardiac enzymes and serum lactate levels should be monitored closely from the time of presentation. (Türk Ped Arş 2014; 49: 314-22)

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children

Boztepe¹,

Yalaki²,

Bilge³

2015

Turk Arch Ped

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“…Myocardial injury may exist in children with CO poisoning, therefore electrocardiogram and cardiac enzymes should be obtained. If abnormal, a cardiac echocardiogram should be obtained [ 206 ].…”

Section: Carbon Monoxidementioning

confidence: 99%

Toxic Ingestions

Sullivan

McDonald

2014

Pediatric Critical Care Medicine

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IntroductionEven with public heightened awareness for potential home toxin exposures, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age [ 1 ]. This represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % of exposures and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %) [ 1 ]. The intensivist must be prepared to care for the children who have serious and sometimes life-threatening exposures. AbstractDespite the public's heightened awareness of potential toxin exposures in children, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, the United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age which represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %). The intensivist must be prepared to care for children who have serious and sometimes life-threatening exposures. Supportive care is the mainstay of therapy because many poisons have no specifi c antidote. Much of the current clinical practices for treating the poisoned patient are based on anecdotal reports because there are limited evidenced-based clinical trials that provide guidance for treatment, safety, and outcome.

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“…Les enfants sont également victimes d'atteinte myocardique comme le confirme une étude récente [21]. Les enfants ayant un taux d'HbCO inférieur à 10 % ont eu un dosage de troponine Ic.…”

Section: Physiopathologieunclassified

Intoxication au monoxyde de carbone et place de l’oxygénothérapie hyperbare

et al. 2011

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Le traitement par oxygénothérapie hyperbare (OHB) lors des intoxications au monoxyde de carbone est utilisé depuis plus de 50 ans. Néanmoins, le protocole à appliquer et le sous-groupe de patients pouvant bénéficier de l'OHB restent débattus. La physiopathologie de l'intoxication au monoxyde de carbone est complexe, expliquant la diversité des tableaux cliniques retrouvés neurologiques (troubles de la conscience et syndrome postintervallaire) mais aussi cardiaques (ischémie à coronaires saines notamment). La physiopathologie fait intervenir une hypoxie ané-mique par formation de carboxyhémoglobine mais aussi une hypoxie hypoxique par blocage de la chaîne respiratoire au niveau de la cytochrome oxydase, un stress oxydatif et des lésions d'ischémie-reperfusion. La carboxyhémoglobine (veineuse ou artérielle) n'est pas à prendre en compte pour le traitement ; le dosage de la troponine Ic au moindre doute est souhaitable. Les bases de traitement par l'OHB reposent d'abord sur des arguments physiopathologiques : détoxifica-tion plus rapide des protéines héminiques, effet antioxydant et amélioration de la physiologie cérébrale (diminution de la pression intracrânienne, diminution de l'oedème et préserva-tion de la zone de pénombre). Les autres arguments sont issus des essais thérapeutiques randomisés. Quatre des cinq études randomisées utilisant une OHB avec une pression supérieure à 2 ATA étaient positives. Deux études à 2 ATA étaient négatives. Ainsi, les recommandations européennes et américaines suggèrent l'utilisation d'OHB à 2,5 ATA au moins dans les situations à risque de séquelles neurologiques (tout signe neurologique objectif y compris perte de connaissance), en cas d'atteinte cardiaque ou de grossesse. Il faut insister sur un traitement par oxygénothérapie à fort débit pendant 8-12 heures en cas de non-indication de l'OHB. Pour citer cette revue : Réanimation 20 (2011). Mots clés Oxygénothérapie hyperbare · Intoxication au monoxyde de carboneAbstract Hyperbaric oxygen (HBO) is used since more than 50 years for carbon monoxide poisoning. However, HBO protocols and indications are still debated. Neurological (coma and delayed neuropsychological sequelae) and cardiac (ischemic changes with normal coronary arteries) clinical scenarios are explained by complex mechanisms. Carboxyhemoglobin formation, cytochrome oxydase inhibition, oxidative stress, as well as ischemia-reperfusion phenomenon are among these mechanisms. Venous and arterial carboxyhemoglobin levels are not correlated with the patient's final prognosis and thus not mandatory for indicating the treatment. Conversely, troponin IC measurement is strongly recommended if myocardial involvement is suspected. HBO treatment relies on mechanistic bases: earlier detoxification, anti-oxidant properties, and improvement in cerebral physiology (decrease in intracranial pressure and oedema, and ischemic penumbra preservation). Clinical basis is assessed by the results of the randomized clinical trials (RCTs). Four among the 5 RCTs using > 2 ATA OHB protocols were p...

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Acute cardiac effects of carbon monoxide poisoning in children

Abstract: Myocardial injury may exist in children with CO poisoning without abnormal ECG findings. GCS score

Cited by 44 publications

References 13 publications

Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children

Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children

Toxic Ingestions

Intoxication au monoxyde de carbone et place de l’oxygénothérapie hyperbare

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