Acute Carbon Monoxide Poisoning in the Emergency Department: A Descriptive Study of 660 Cases in Tunisia

Carbon monoxide (CO) poisoning is a frequent and potentially fatal medical emergency, accounting for significant global morbidity and mortality.

This study aims to determine the epidemiological and clinical characteristics of patients presenting to the emergency department (ED) with acute CO poisoning in Tunisia.

A retrospective, descriptive, single-center study was conducted at the ED of Mahmoud Yacoub Center for Urgent Medical Assistance in Tunis over two years. Patients aged over 12 years with acute CO poisoning were included. Epidemiological data, clinical presentation, severity, laboratory findings, and management were analyzed.

A total of 660 cases were included, all secondary to accidental exposure. The mean age was 35 ±15 years, with a female predominance (73%). CO poisoning was most frequent during winter (70.4%). The main source was gas water heaters (78.2%). Severe cases of CO poisoning were observed in 27.9% of patients, with neurological symptoms in 90.8% of them. The median carboxyhemoglobin level was 21% [13-29]. In univariate analysis, age ≥50, asthenia, chest pain, carboxyhemoglobin ≥25%, and hyperleukocytosis were associated with severe CO poisoning, with hyperleukocytosis remaining an independent predictor in multivariate analysis. Oxygen therapy was administered to all patients, and hyperbaric oxygen therapy was performed in 10.6%. Hospitalization was required in 21% cases. No deaths were recorded in our series.

CO poisoning remains a significant public health concern in Tunisia, predominantly affecting young adults, with water heaters as the leading source. Neurological and cardiac manifestations predominate in severe cases.