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Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?

Year 2019, Volume: 1 Issue: 2, 57 - 60, 17.07.2019

Abstract

Objectives: The
aim of this study was to determine whether there was a significant relationship
between carboxyhemoglobin levels and plasma lactate levels at the time of
admission in patients who had been admitted to the emergency department due to
carbon monoxide intoxication.

Materials ad Methods: In
this retrospective-cross-sectional study, patients diagnosed with toxic effects
of carbon monoxide were evaluated among the patients admitted to the emergency
department between 01.01.2013-01.01.2017. Blood gas data obtained from the
peripheral artery in the first 30 minutes of patients’ admission to the
emergency department  were examined.
Patients were classified as Group 1 (10% -20%) and Group 2 (20% and above)
according to their carboxyhemoglobin levels.

Results: A
total of 404 patients were included in the study. The mean carboxyhemoglobin
level was 21.2 ± 8% for all cases and 14.6 ± 3% for Group 1 and 27.8 ± 6% for
Group 2. The difference between the two groups was statistically significant
(mean difference 13.2; 95% CI = 12,198-14,157) (p <0.001). The number of
patients with lactate levels above normal in Group 2 was higher than Group 1 (p
<0.001). There was a significant difference in lactate levels between two
exposure groups (p <0.001). At the same time, when all parameters were
evaluated, there was a correlation between carboxyhemoglobin levels and lactate
levels (r = 0,601, p <0,001). In the ROC analysis to determine the value of
lactate levels in the diagnosis of severe exposure (Group 2), AUC was
calculated as 0,791 (95% confidence interval, 0.748-0.835; p <0.001; Figure
1). The positive predictive value for lactate level 3 mmol/L was 88% and the
negative predictive value was 63% and this level could be used as cut-off
value.

Conclusion: In
the evaluation of cases of carbon monoxide poisoning, the question of whether
plasma lactate level can be used as a marker is still being discussed.
Based on the significant results that we found in our
study, plasma lactate levels ,which is correlated with
carboxyhemoglobin levels, may be
helpful in the classification and evaluation of patients with carbon monoxide
intoxication. 

References

  • 1. Satar S, Seydaoglu G, Akpinar A, Sebe A, Karakoc E, Gumusay U, et al. Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome. Bratisl Lek Listy. 2009;110(7):404–11.
  • 2. Kao LW, Nañagas KA. Carbon monoxide poisoning. Emerg Med Clin North Am. 2004;22(4):985-1018. doi:10.1016/j.emc.2004.05.003
  • 3. Koylu R, Dundar ZD, Koylu O, Akinci E, Akilli NB, Gonen MO, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6(1):59-65. doi:10.4021/jocmr1687w
  • 4. Maloney G. Carbon monoxide. In: Tintinalli JE, editor. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. p. 1410–3.
  • 5. Koruk S, Tuncel I, Mizrak A, Hengirmen Akcali A, Ganidagli S. Cerebrovascular changes and EEG findings in carbon monoxide intoxication: case report. J Emerg Med CASE REPORTS. 2010;1(2):23–6.
  • 6. Smollin C, Olson K. Carbon monoxide poisoning ( acute ). BMJ Clin Evid. 2010;(June):1–12.
  • 7. Weaver LK. Carbon Monoxide Poisoning. N Engl J Med. 2009;360(12):1217-25. doi:10.1056/NEJMcp0808891
  • 8. Thom SR. Carbon monoxide pathophsyology and treatment. In: Neuman TS, Thom SR, editors. Phsyology and Medicine of Hyperbaric Oxygen Therapy. Philadelphia: Saunders/Elsevier; 2008. p. 321–47.
  • 9. Cervellin G, Comelli I, Rastelli G, Picanza A, Lippi G. Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients. Clin Biochem. 2014;47(18):298-301. doi:10.1016/j.clinbiochem.2014.09.016
  • 10. Thom SR, Hampson NB, Mathieu-Nolf M, Raub JA. Carbon monoxide poisoning - a public health perspective. Toxicology. 2000;145(1):1-14. doi:10.1016/s0300-483x(99)00217-6
  • 11. Benaissa ML, Megarbane B, Borron SW, Baud FJ. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning? Intensive Care Med. 2003;29(8):1372-5. doi:10.1007/s00134-003-1866-0
  • 12. Jeong Mi Moon, Min Ho Shin, Byeong Jo Chun. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol. 2011;30(8):836-43. doi:10.1177/0960327110384527
  • 13. Doğan N, Savrun A, Levent S, Günaydin GP, Çelik GK, Akküçük H, et al. Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning? Hum Exp Toxicol. 2015;34(3):324-9. doi:10.1177/0960327114538986
Year 2019, Volume: 1 Issue: 2, 57 - 60, 17.07.2019

Abstract

Amaç: Bu çalışmanın amacı karbonmonoksit zehirlenmesi nedeniyle acil servise başvurmuş olan olguların başvuru anındaki plazma laktat düzeyi ile COHb düzeyleri arasında anlamlı bir ilişki olup olmadığını değerlendirmektir.

Gereç ve Yöntem: Retrospektif-kesitsel bu çalışmada, 01.01.2013-01.01.2017 tarihleri arasında acil servise başvurmuş olgular arasından, hastane veri sisteminde ‘Karbonmonoksitin toksik etkisi’ tanı kodu mevcut olanlar incelendi. Hastalar karboksihemoglobin düzeylerine göre Grup 1 (%10-%20 arası) ve Grup 2 (%20 ve üstü) şeklinde sınıflandırıldı.

Bulgular: Çalışmaya toplam 404 olgu dahil edildi. Tüm olgular için ortalama karboksihemoglobin düzeyi %21,2±8 olup, Grup 1 için ortalama %14,6±3, Grup 2 için ise %27,8±6 olarak hesaplandı. İki grup arasındaki bu fark istatistiksel olarak anlamlıydı (ortalama fark, 13,2; %95 GA= 12,198-14,157) (p<0,001). Grup 2’de normalin üstünde laktat değerleri tespit edilen olgu sayısı, Grup 1’e göre fazlaydı (p<lt;0,001). İki maruziyet grubu arasında laktat değerleri açısından anlamlı fark tespit edildi (p<0,001). Karboksihemoglobin düzeyleri ile laktat seviyeleri arasında korelasyon mevcuttu (r=0,601, p<0,001). Ciddi maruziyet (Grup 2) tanısında laktat düzeylerinin değerliliğini araştırmak için oluşturulan ROC analizinde, AUC 0,791 olarak hesaplandı (95% güven aralığında , 0.748–0.835; p<0,001; Şekil 1).

Sonuç: Karbonmonoksit zehirlenmesi olgularının değerlendirilmesinde, plazma laktat düzeyinin bir belirteç olarak kullanılabileceği konusu hala tartışmalıdır. Çalışmamız, saptamış olduğumuz anlamlı sonuçlara dayanarak, karboksihemoglonin düzeyi ile korele bir yükseliş gösterdiğinden plazma laktat düzeylerinin olguların sınıflandırılmasında kullanılabileceğini göstermiştir.

References

  • 1. Satar S, Seydaoglu G, Akpinar A, Sebe A, Karakoc E, Gumusay U, et al. Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome. Bratisl Lek Listy. 2009;110(7):404–11.
  • 2. Kao LW, Nañagas KA. Carbon monoxide poisoning. Emerg Med Clin North Am. 2004;22(4):985-1018. doi:10.1016/j.emc.2004.05.003
  • 3. Koylu R, Dundar ZD, Koylu O, Akinci E, Akilli NB, Gonen MO, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6(1):59-65. doi:10.4021/jocmr1687w
  • 4. Maloney G. Carbon monoxide. In: Tintinalli JE, editor. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. p. 1410–3.
  • 5. Koruk S, Tuncel I, Mizrak A, Hengirmen Akcali A, Ganidagli S. Cerebrovascular changes and EEG findings in carbon monoxide intoxication: case report. J Emerg Med CASE REPORTS. 2010;1(2):23–6.
  • 6. Smollin C, Olson K. Carbon monoxide poisoning ( acute ). BMJ Clin Evid. 2010;(June):1–12.
  • 7. Weaver LK. Carbon Monoxide Poisoning. N Engl J Med. 2009;360(12):1217-25. doi:10.1056/NEJMcp0808891
  • 8. Thom SR. Carbon monoxide pathophsyology and treatment. In: Neuman TS, Thom SR, editors. Phsyology and Medicine of Hyperbaric Oxygen Therapy. Philadelphia: Saunders/Elsevier; 2008. p. 321–47.
  • 9. Cervellin G, Comelli I, Rastelli G, Picanza A, Lippi G. Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients. Clin Biochem. 2014;47(18):298-301. doi:10.1016/j.clinbiochem.2014.09.016
  • 10. Thom SR, Hampson NB, Mathieu-Nolf M, Raub JA. Carbon monoxide poisoning - a public health perspective. Toxicology. 2000;145(1):1-14. doi:10.1016/s0300-483x(99)00217-6
  • 11. Benaissa ML, Megarbane B, Borron SW, Baud FJ. Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning? Intensive Care Med. 2003;29(8):1372-5. doi:10.1007/s00134-003-1866-0
  • 12. Jeong Mi Moon, Min Ho Shin, Byeong Jo Chun. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol. 2011;30(8):836-43. doi:10.1177/0960327110384527
  • 13. Doğan N, Savrun A, Levent S, Günaydin GP, Çelik GK, Akküçük H, et al. Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning? Hum Exp Toxicol. 2015;34(3):324-9. doi:10.1177/0960327114538986
There are 13 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Sinem Doğruyol

İlker Akbaş

Erdal Tekin

Publication Date July 17, 2019
Submission Date December 28, 2018
Published in Issue Year 2019 Volume: 1 Issue: 2

Cite

APA Doğruyol, S., Akbaş, İ., & Tekin, E. (2019). Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?. Eurasian Journal of Toxicology, 1(2), 57-60.
AMA Doğruyol S, Akbaş İ, Tekin E. Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?. Eurasian J Tox. July 2019;1(2):57-60.
Chicago Doğruyol, Sinem, İlker Akbaş, and Erdal Tekin. “Plasma Lactate Levels in Carbon Monoxide Intoxication, Can Be Used at First Step?”. Eurasian Journal of Toxicology 1, no. 2 (July 2019): 57-60.
EndNote Doğruyol S, Akbaş İ, Tekin E (July 1, 2019) Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?. Eurasian Journal of Toxicology 1 2 57–60.
IEEE S. Doğruyol, İ. Akbaş, and E. Tekin, “Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?”, Eurasian J Tox, vol. 1, no. 2, pp. 57–60, 2019.
ISNAD Doğruyol, Sinem et al. “Plasma Lactate Levels in Carbon Monoxide Intoxication, Can Be Used at First Step?”. Eurasian Journal of Toxicology 1/2 (July 2019), 57-60.
JAMA Doğruyol S, Akbaş İ, Tekin E. Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?. Eurasian J Tox. 2019;1:57–60.
MLA Doğruyol, Sinem et al. “Plasma Lactate Levels in Carbon Monoxide Intoxication, Can Be Used at First Step?”. Eurasian Journal of Toxicology, vol. 1, no. 2, 2019, pp. 57-60.
Vancouver Doğruyol S, Akbaş İ, Tekin E. Plasma Lactate Levels in Carbon Monoxide Intoxication, Can be Used at First Step?. Eurasian J Tox. 2019;1(2):57-60.

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