Segovia-Arevalo MS, Ramírez-Galindo MR

Language: Spanish
References: 9
Page: 222-227
PDF size: 226.72 Kb.

ABSTRACT

Carbon monoxide (CO) is a product of incomplete combustion of any compound containing carbon, it is an odorless, colorless and tasteless gas, characteristics that make it difficult to detect in the environment, making it one of the main causes of morbidity and mortality due to poisoning,1 The clinical presentation is nonspecific, therefore, a high suspicion and a history of exposure to a source of carbon monoxide are vital to ensure optimal treatment and timely identification of complications.1 CO poisoning has a lethality that varies between 2% and 31%;2 one of the main associated complications is rhabdomyolysis, reported in 20%, with secondary acute kidney injury (AKI). The damaging mechanism that causes AKI is determined by vasoconstriction, ischemia and direct tubular injury by massive release of myoglobin into the circulation, directly affecting the nephron. Renal replacement therapy with intermittent hemodialysis or continuous techniques increases myoglobin clearance, which contributes to an earlier recovery, avoiding long-term sequelae.
The case of a 23-year-old female is presented, who entered the emergency room of a second level hospital after being found unconscious in a closed space. During the clinical evolution, elevated levels of carboxyhemoglobin were found, which is why she received a diagnosis of severe carbon monoxide poisoning, presenting complications such as rhabdomyolysis and acute kidney injury (McMahon index of 10 points) requiring renal replacement therapy with intermittent hemodialysis, after which there was clear improvement, achieving hospital discharge and outpatient follow-up.

REFERENCES

1. Hoffman R, Howland MA, Lewin N, Nelson L, Goldfrank L. Goldfrank’sToxicologic Emergencies, Tenth Edition. McGraw Hill Professional;

2. 2014: 1663-1672.

3. Mégarbane B. Carbon monoxide intoxication in the 21st century:the battle to improve outcomes continues. Emergencias : revistade la Sociedad Espanola de Medicina de Emergencias. 2019;315:300-301.

4. RodrigoPoblete U, FernandaBellolio A, Miguel J, Mardónez U,Saldías F. Series Clínicas de Medicina de Urgencia: Intoxicaciónpor monóxido de carbono, el gran simulador.

5. Pimentel LR, Gámiz AW, Santamaría R, Romo RS. Panorama epidemiológicode las intoxicaciones en México. 21:123-132.

6. Chenoweth J, Albertson T, Greer M. Carbon Monoxide Poisoning.Critical care clinics. 2021;37 3:657-672.

7. Eichhorn L, Thudium M, Jüttner B. The Diagnosis and Treatmentof Carbon Monoxide Poisoning. Deutsches Arzteblatt international.2018;115 51-52:863-870.

8. Esposito P, Estienne L, Serpieri N, et al. Rhabdomyolysis-AssociatedAcute Kidney Injury. American journal of kidney diseases:the official journal of the National Kidney Foundation. 2018;716:A12-A14.

9. Premru V, Kovač J, Ponikvar R. Use of Myoglobin as a Marker