The diversity of carbon monoxide intoxication: medical courses can differ extremely-a case report

Intoxications of carbon monoxide are frequent and may affect systems of lung, heart, and brain, leading to coma or death in severe cases. In this case report, we present two adults who were exposed to the same source of carbon monoxide for a nearly equal period of time. The first patient, a 28-yr-old female, developed massive symptoms including loss of consciousness, respiratory insufficiency, and lung complications resulting in severe lung edema. She was intubated and ventilated for 43 h before she recovered and could be extubated. The other patient, a 22-yr-old male, recovered immediately and was fully orientated after applying an oxygen mask at the scene of incident. After admission to the intensive care unit, both patients showed an equally high serum level of COHb and received hyperbaric oxygen therapy. The male patient was discharged from hospital the following day, whereas the female remained in intensive care for 4 days. A satisfactory explanation could not be found for the difference in the clinical progression in these two cases. However, this case report shows that, in spite of almost equal serum levels of carboxyhemoglobin (COHb), the individual symptoms can vary extremely. Therefore, a detailed medical history, physical examination, supporting diagnostic measures, and the continuous monitoring of vital parameters in a specialized clinic are essential.