Pediatric carbon monoxide toxicity

We report a series of 28 pediatric carbon monoxide exposures. Sixteen patients (57%) were judged to have potentially toxic carboxyhemeglobin (COHb) levels (greater than 15%). In this group the range of COHb blood levels was 16.7% to 44.0% (mean = 26.5%). An unusually high incidence of syncope (56.3%, 9/16) and lethargy (68.7%, 11/16) was observed. Every patient with a COHb level greater than or equal to 24% experienced syncope; a marked departure from published adult values. Lethargy was reported at a mean COHb concentration of 25.9%. All patients with levels over 25% COHb, neurologic findings, acidosis, or syncope were considered candidates for hyperbaric oxygen therapy (HBOT). No morbidity from HBOT was encountered. Eighty-nine percent (25/28) of the patients are reportedly doing well, with no late sequelae identified. Delayed neurologic sequelae in three patients include chronic headaches, memory difficulties, or decline in school performance.