Approach to Carbon Monoxide (CO) Poisoning in the PICU
May 25, 2025
A gripping case unfolds as a 16-year-old battles severe carbon monoxide poisoning after being found unresponsive. The discussion dives into the pathophysiology behind this toxic exposure and its alarming effects on hemoglobin. Key insights include the urgency of early oxygen administration and the potential for neurological complications. Experts outline essential diagnostic methods and management strategies while emphasizing the need for a multidisciplinary approach. The impact on cardiac health is also highlighted, making this a must-listen for pediatric care.
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Severe CO Poisoning Case
A 16-year-old male was found unresponsive in a garage with severe carbon monoxide poisoning.
He developed ventricular tachycardia and required intubation, cyanokit, and 100% oxygen therapy in the PICU.
insights INSIGHT
Carboxyhemoglobin Curve Explained
The carboxyhemoglobin dissociation curve lies below and is left-shifted compared to oxyhemoglobin.
This causes less oxygen delivery and impaired release to tissues, leading to tissue hypoxia despite normal PaO2.
insights INSIGHT
CO Toxicity Mechanisms
Carbon monoxide binds hemoglobin 200 times more tightly than oxygen and inhibits mitochondrial cytochrome C oxidase.
This dual action causes cellular hypoxia, metabolic acidosis, and end-organ dysfunction including oxidative stress and demyelination.
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In this episode of "PICU Doc on Call," pediatric intensivists Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray discuss a critical case involving a 16-year-old male who experienced severe carbon monoxide poisoning after being found unresponsive in a garage. They chat about the pathophysiology, clinical manifestations, diagnostic workup, and management of carbon monoxide toxicity. Furthermore, they cover the importance of early oxygen administration, recognizing potential delayed neurological sequelae, and keeping an eye out for cardiac complications. Tune in and hear more about a comprehensive approach to treatment and the significance of multidisciplinary support for achieving the best patient outcomes.
Show Highlights:
Case presentation of a 16-year-old male with severe carbon monoxide poisoning
Pathophysiology of carbon monoxide toxicity and its effects on hemoglobin
Clinical manifestations and symptoms associated with carbon monoxide poisoning
Diagnostic workup for suspected carbon monoxide exposure
Management principles for treating carbon monoxide poisoning in pediatric patients
Sources and scenarios leading to carbon monoxide poisoning
Complications arising from carbon monoxide exposure including neurological injuries
Importance of early oxygen administration and monitoring in treatment
Discussion of hyperbaric oxygen therapy and its indications
Key takeaways for clinicians regarding the management and follow-up of carbon monoxide poisoning cases
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References:
Tapking, C., et al. (2021). Burn and inhalation injury. In J. J. Zimmerman & A. T. Rotta (Eds.), Fuhrman and Zimmerman’s Pediatric Critical Care (6th ed., pp. 1347–1362). Elsevier.
Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624.
Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010 Oct 12;2010:2103. PMID: 21418677; PMCID: PMC3217756.
Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
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