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A case of open-air carbon monoxide poisoning in a 10-year-old boy

2001; Elsevier BV; Volume: 21; Issue: 3 Linguagem: Inglês

10.1016/s0736-4679(01)00395-x

2352-5029

Michael A. Wilson, Peter Rosén,

Injury Epidemiology and Prevention

A 10-year-old boy from Salt Lake City, Utah, presented to the Emergency Department in Jackson, Wyoming, after two syncopal episodes that day. His past medical history was limited to an asthma attack 4 years earlier, but he had none since and was taking no medication. Otherwise he had no health problems and had been feeling well and healthy earlier in the day. The boy had been with his family on a local lake riding in an open motorboat when he began to feel confused and “passed out.” He later indicated having felt nauseated and having a headache beforehand. He “came to” on the dock then proceeded to have another syncopal stiffening. The patient’s O2 saturation was in the mid 90s while on the dock and in the ambulance and was 91% in the Emergency Department. Physical examination was completely within normal limits, and electrocardiogram was also normal. Complete blood count and a basic metabolic panel were both normal, as was the arterial blood gas. Somewhat as an afterthought, the boy’s grandfather mentioned noticing the smell of exhaust while in the boat. At that time carbon monoxide (CO) poisoning was not considered likely, given the fact that the boat was open air and that the patient’s O2 saturation was decreased (possibly from increased altitude) instead of normal. However, given the comment regarding the exhaust smell, hemoximetry was performed and showed a carboxyhemoglobin level of 10.6% (normal <1.5%) and a Hb O2 saturation of 84.8%. The boy was placed on O2 non-rebreather mask at 10 L/min for 2 hours after which his Hb CO level had decreased to 2.1%. The Poison Control Center in Salt Lake City was consulted and did not feel that hyperbaric oxygen treatment was useful because of the 300-mile travel distance to their chamber. The patient was discharged with instructions to terminate the vacation and to see his primary care provider after returning home. Additionally, he was instructed to seek prompt assessment and treatment if he should pass out again. Per a follow up telephone call 3 months later, the boy had no subsequent syncopal episodes or seizures and was doing well.