Lactic Acidosis from Carboxyhemoglobinemia After Smoke Inhalation

Buehler, John; Berns, Arnold S.; Webster, James R.; Addington, Whitney W.; Cugell, David W.

doi:10.7326/0003-4819-82-6-803

Cited by 29 publications

(8 citation statements)

References 11 publications

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“…Several mechanisms can explain why past smokers are more susceptible to dietary acid load than never smokers. Quitting smoking can avoid further damage but does not remove past damages by smoking [16,52]; smoking can further damage the acid-base regulating systems [53][54][55][56] and can promote acidosis in patients with or without cancer [13,14]. All of these factors help explain the mechanisms associated with the accelerated risk of total mortality, breast cancer-specific mortality and recurrence for past smokers among breast cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

“…Cancer survivors have a reduced capacity to adjust their acid-base balance [12] and thus they may be more susceptible to acid-producing diets. Furthermore, among cancer survivors, past smokers have a lower capacity to adjust their acid-base balance than never smokers acidosis [13][14][15]. Past smokers accounted for up to 35-40% of breast cancer survivors, whereas current smokers only accounted for 4-6% [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses among Breast Cancer Survivors: A Prospective Cohort Study

Hsu

Pierce

2020

JCM

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Current dietary guidelines do not consider cancer survivors’ and past smokers’ low capacity to regulate their acid–base balance. People with a low capacity to regulate their acid–base balance are more susceptible to acid-producing diets. We studied a cohort of 2950 early stage breast cancer survivors who provided dietary information at baseline and during follow-up. We assessed the intakes of acid-producing diets via two commonly used dietary acid load scores: potential renal acid load (PRAL) and net endogenous acid production (NEAP). We assessed past smoking intensity by pack-years of smoking. After an average of 7.3 years of follow-up, there were 295 total deaths, 249 breast cancer-specific deaths, and 490 cases of recurrent breast cancer. Increased intakes of dietary acid load and pack-years of smoking were each independently and jointly associated with increased total mortality and breast cancer-specific mortality; tests for trends and overall associations were statistically significant for NEAP and marginally significant for PRAL. Compared to women in the lowest tertile of NEAP and pack-year of smoking = 0, women in the highest tertile of NEAP and pack-years of smoking >15 had the greatest increased risk of total mortality (HR = 3.23, 95%CI 1.99–5.26). Further, dietary acid scores were associated with increased breast cancer recurrence among women with pack-years of smoking >0 but not in those with pack-years of smoking = 0 (p values for interactions <0.05). Our study provides valuable evidence for adding dietary acid load scores to dietary guidelines for breast cancer survivors and developing specific guidelines for past smokers among these survivors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses among Breast Cancer Survivors: A Prospective Cohort Study

Hsu

Pierce

2020

JCM

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“…In carbon monoxide poisoning, tissue hypoxia, which is the result of deterioration in mitochondrial oxidative capacity, causes lactate increase. In the situations of loss of consciousness or coma, which are considered to be the sign of severe CO poisoning lactate levels are found to be high (20)(21)(22). In some studies, positive correlation was found between COHb and lactate, and it was reported that the lactate level could be used to indicate the severity of CO intoxication (8,14,23).…”

Section: Discussionmentioning

confidence: 99%

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

2020

JSTR

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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.

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“…CO also increases hemoglobin's oxygen affinity, reducing the P 50 of hemoglobin and impairing oxygen release to tissues (28, 29). Oxygen delivery is particularly compromised in the earliest phase of resuscitation, when COHb levels are high, and lactic acidosis occurs because of reduced oxygen availability for metabolism (30 - 32). In this early phase of resuscitation, oxygen tanks may be unavailable and the only possible therapeutic intervention may be to physically remove the patient from continued CO exposure.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Phototherapy to Treat Carbon Monoxide Poisoning in Rats

Zazzeron

Liu

Franco

et al. 2017

Shock

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Background Carbon monoxide (CO) poisoning is a common cause of poison-related mortality. CO binds to hemoglobin in the blood to form carboxyhemoglobin (COHb), impairing oxygen delivery to peripheral tissues. Current treatment of CO poisoned patients involves oxygen administration to rapidly remove CO and restore oxygen delivery. Light dissociates CO from COHb with high efficiency. Exposure of murine lungs to visible laser-generated light improved the CO elimination rate in vivo. The aims of this study were to apply pulmonary phototherapy to a larger animal model of CO poisoning, to test novel approaches to light delivery, and to examine the effect of chemiluminescence-generated light on the CO elimination rate. Methods Anesthetized and mechanically ventilated rats were poisoned with CO and subsequently treated with air or oxygen combined with or without pulmonary phototherapy delivered directly to the lungs of animals at thoracotomy, via intrapleural optical fibers or generated by a chemiluminescent reaction. Results Direct pulmonary phototherapy dissociated CO from COHb reducing COHb half-life by 38%. Early treatment with phototherapy in critically CO poisoned rats improved lactate clearance. Light delivered to the lungs of rats via intrapleural optical fibers increased the rate of CO elimination without requiring a thoracotomy, as demonstrated by a 16% reduction in COHb half-life. Light generated in the pleural spaces by a chemiluminescent reaction increased the rate of CO elimination in rats breathing oxygen, reducing the COHb half-life by 12%. Conclusions Successful application of pulmonary phototherapy in larger animals and humans may represent a significant advance in the treatment of CO poisoned patients.

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Lactic Acidosis from Carboxyhemoglobinemia After Smoke Inhalation

Cited by 29 publications

References 11 publications

Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses among Breast Cancer Survivors: A Prospective Cohort Study

Increased Acid-Producing Diet and Past Smoking Intensity Are Associated with Worse Prognoses among Breast Cancer Survivors: A Prospective Cohort Study

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

Pulmonary Phototherapy to Treat Carbon Monoxide Poisoning in Rats

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