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Carbon monoxide and myonecrosis: a prospective study.
A B Shapiro1, A Maturen, G Herman
1University of Illinois, Department of Medicine, Chicago 60612.
Veterinary and Human Toxicology
|April 1, 1989
Summary
Carbon monoxide (CO) poisoning does not correlate with rhabdomyolysis. However, elevated thiocyanate levels, linked to cyanide, may be associated with rhabdomyolysis in toxic inhalation cases.
Area of Science:
- Toxicology
- Emergency Medicine
- Neurology
Background:
- Myonecrosis and rhabdomyolysis are potential complications of carbon monoxide (CO) poisoning.
- Previous case reports suggest a link between CO poisoning and rhabdomyolysis, particularly after smoke inhalation.
Purpose of the Study:
- To prospectively investigate the association between CO poisoning and rhabdomyolysis.
- To determine if CO levels or thiocyanate levels correlate with elevated serum creatine kinase (CPK) levels in patients with CO poisoning.
Main Methods:
- Prospective study of 81 consecutive patients presenting with CO levels >5.0%.
- Serum CO and creatine kinase (CPK) levels were measured in 65 patients.
- Thiocyanate levels were measured in 45 patients.
- Linear regression analysis was used to assess correlations.
Main Results:
- No statistically significant correlation was found between CO levels and CPK levels.
- A significant association was observed between thiocyanate levels and CPK levels (p < 0.02), with a power curve providing a better fit (r2 = 0.7).
- Weakness was reported in 4 patients, with physical evidence in one, but none had elevated CPK levels.
Conclusions:
- Routine measurement of serum CPK levels in CO poisoning patients is not recommended.
- Cyanide, indicated by thiocyanate levels, may play a more significant role in non-traumatic rhabdomyolysis associated with toxic inhalation than previously recognized.