Carbon Monoxide Poisoning In Children: Which Cases Should Receive Advanced Cardiologic Evaluation?

Abstract

This study aimed to determine the relationship between carboxy-hemoglobin (COHb) and neurological and cardiac effects in patients admitted to our pediatric emergency department with CO poisoning and identify the patients who require advanced cardiologic evaluation. Materials and methods: Between January 2013 and January 2016, 412 children with carbon monoxide poisoning admitted to our hospital were evaluated retrospectively. Results: The incidence of COHb, lactate, CK-MB (creatinine kinase-myocardial band), troponin I and BNP (B-type natriuretic peptide) levels were higher in patients with who had altered state of consciousness (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Hypotension was found in 8 (27.6%) of 29 (7%) patients with a Glasgow coma scale (GCS) score of 14 and below. BNP and troponin I levels were found to be high in patients with hypotension. For cardiac involvement, the sensitivity and specificity of COHb 20.1% value were 50.0% and 72.4%, respectively; and lactate at 2.95 mmol/L had a sensitivity and specificity value of 41.2% and 82.4% respectively. Conclusion: High BNP levels may be useful in determining the severity of intoxication in patients with altered state of consciousness. Cardiological evaluation should be performed in patients with a GCS score of 14 or lower or hypotension.