Prognostic Value of Initial Arterial Lactate Levels in Childhood Acute Carbon Monoxide Poisoning

Objective: To compare the prognostic values of lactate and carboxyhemoglobin (COHb) levels on clinical neurological and cardiac involvement in children with carbon monoxide poisoning Design: Clinical Trial (Prospective Study), over a two year period Setting: Pediatrics Emergency Department, Eskisehir Osmangazi University School of Medicine, Turkey Subjects and Methods: A total of 77 children aged one month to 17 years who were referred to the pediatric emergency department (PED) between 1st April 2009 and 30th April 2011 and diagnosed with carbon monoxide intoxication were assessed for age, gender, symptoms, clinical findings, blood lactate levels, COHb levels, morbidity and mortality. Intervention: Patients with more than 5% COHb, lactate, CK-MB (creatine kinase-myocardial band) and troponin levels were studied. Main Outcome Measures: Symptoms, laboratory results and neurological and cardiac complications were studied to determine whether there is a correlation among patients with neurologic and cardiac signs and COHb and lactate levels the latter being a marker for tissue hypoxemia. Increased CK-MB and troponin levels were evaluated as markers of cardiac involvement. Results: There was a significant positive correlation between initial lactate levels in blood gas analysis, early neurologic findings and delayed neurological sequelae (DNS) and cardiac involvement as compared to COHb levels. Conclusion: The initial lactate levels have higher prognostic value for cardiac involvement and DNS as compared to COHb and it may be helpful for treatment.