CARDIOGENIC SHOCK AND GLOBUS PALLIDUS INJURY AS A PRESENTATION OF CARBON MONOXIDE POISONING

Area of Science:

• Toxicology
• Emergency Medicine
• Neurology

Background:

• Carbon monoxide (CO) poisoning is a significant global cause of mortality and morbidity.
• Clinical signs of CO poisoning are often nonspecific, affecting organs with high oxygen demand, particularly the brain.
• Carbon monoxide-hemoglobin (CO-Hb) levels are unreliable indicators of severity; clinical features and laboratory findings are crucial for assessment.

Purpose of the Study:

• To report a rare, severe case of carbon monoxide intoxication presenting with coma, globus pallidus injury, and cardiogenic shock.
• To highlight the efficacy of hyperbaric oxygen treatment in managing severe carbon monoxide poisoning.

Main Methods:

• A case report of a 45-year-old female with severe carbon monoxide intoxication.
• Clinical assessment included neurological status, cardiac function (ECG, echocardiogram), and laboratory tests (CO-Hb, lactate, renal function, troponin I).
• Treatment involved hyperbaric oxygen therapy.

Main Results:

• The patient presented in a coma with cardiogenic shock, metabolic acidosis, hyperlactacidemia, and evidence of multi-organ dysfunction (liver, kidneys, rhabdomyolysis).
• Cranial CT revealed characteristic bilateral globus pallidus hypodensities, indicating brain injury.
• Following hyperbaric oxygen treatment, the patient experienced complete neurological and cardiac recovery and was extubated within 48 hours.

Conclusions:

• Severe carbon monoxide poisoning can lead to significant neurological and cardiac complications, including globus pallidus injury and cardiogenic shock.
• Hyperbaric oxygen therapy is an effective treatment for severe carbon monoxide intoxication, demonstrating excellent outcomes for neurological and cardiac function.
• This case underscores the importance of considering hyperbaric oxygen therapy in severe carbon monoxide poisoning cases.