Research Information System
20. Ulusal Acil Tıp Kongresi & 11th Intercontinental Emergency Medicine Congress & 11th International Critical Care and Emergency Medicine Congress, Antalya, Turkey, 16 - 19 May 2024, pp.877-878
Acute carbon monoxide poisoning and anoxic brain ınjury
ABDİL ÇOŞKUN 1 , EVREN DÖNMEZ 1 , MURTAZA KAYA 1 , HARUN YILDIRIM 1 , ALİ HALICI 1 , ERTAN SÖNMEZ 1
Introduction and Purpose: Numerous patients present to the emergency department due to carbon monoxide poisoning, which often presents with nonspecific symptoms. While headaches
are common, some individuals may arrive unconscious. In this case, we aimed to draw attention to the anoxic brain injury underlying the clinical presentation of a patient brought unconscious to
the emergency department, attributed to carbon monoxide intoxication.Carbon monoxide has an affinity to hemoglobin approximately 250 times greater than that of oxygen, leading to the
formation of carboxyhemoglobin, which reduces the oxygen-carrying capacity of blood and causes tissue hypoxia. Neurons are the most vulnerable cells to hypoxic-ischemic damage, as
they have the highest oxygen and glucose requirements.
Materials and Methods: Case Presentation A 50-year-old female patient was brought to the emergency department in the morning by her relatives after being found unconscious. She had no
known medical history. According to the history obtained from her relatives, the patient lived in a house with a coal stove, and she was last seen normal around 6:00 PM yesterday.During the
patient's presentation, vital signs were within normal limits. On physical examination, Glasgow Coma Scale (GCS) was 5 (E:1 V:1 M:3), with bilateral miosis noted. The EKG showed sinus
tachycardia. Pathological laboratory findings included a pH of 7.15, lactate level of 9.6 mmol/L, carboxyhemoglobin (COHb) level of 27.1%, and Troponin I level of 144.1 ng/L (normal range:
0-11.6). After being intubated with rapid sequence intubation (RSI) in the emergency department, the patient underwent imaging studies. A non-contrast CT scan of the brain did not
reveal any acute pathology, but diffusion-weighted MRI showed extensive acute diffusion restriction in the bilateral basal ganglia and left parieto-occipital region (Figures 1-2). The patient
received hyperbaric oxygen therapy and was admitted to the intensive care unit (ICU). Following intensive care monitoring, the patient was discharged with right hemiplegia, requiring respiratory
support via tracheostomy.
The patient's MRI Diffusion image and ADC section
Diffusion-weighted MRI showed extensive acute diffusion restriction in the bilateral basal ganglia and left parieto-occipital region (Figures 1-2)
The patient's MRI Diffusion image and ADC section
Diffusion-weighted MRI showed extensive acute diffusion restriction in the bilateral basal ganglia and left parieto-occipital region (Figures 1-2)
Results and Conclusion: Carbon monoxide intoxication is commonly encountered in the emergency department, especially during the winter months. It can manifest with a wide range of
clinical presentations. Carbon monoxide poisoning should be considered in patients presenting with loss of consciousness.
Keywords: Carbon monoxide, emergency medicine, acute brain injury