[Determination of serum lactic acid and the acid-base equilibrium in carbon monoxide poisoning]

The authors present a description of severe accidental carbon monoxide poisoning. They stress the significance of the examination of lactic acid level at this poisoning. In case described the level of carbonyl haemoglobin could not be determined because of device trouble. Patient AA (16-year-old) was admitted in relatively very good condition, without clinical signs of severer affection. Considering the facts that gas-poisoning (over 24 hrs) was found through anamnesis, and simultaneous admission of patient's greatgrandmother in critical condition, the patient AA was treated also with oxygen of high concentration, monitored, kept in absolute rest. High lactate level (18.9 mmol/l) and the evidence of metabolic acidosis (pH 7.16, pO2 8.65, pCO2 2.06, sBE -22.1) made to suspect of severe poisoning. Despite intensive oxygenotherapy it came to severe left-side cardial failure associated with pulmonal edema, anuria, shock after 4 hours, managed successfully within 4 hours. Lactate level correlated very well with condition severity. Septum hypokinesis was demonstrated cardiografically and it disappeared within 6 days. However, symetric inversion of T wave in many leads (I, II, aVF, V 2-6) persisted for 24 days. The authors assume that routine examination of acid base balance and lactate level in addition to the determination of carbonyl haemoglobin level is very important for the consideration of the severity of carbon monoxide poisoning. Lactataemia determination is probably even more significant for the assumption of oxygen deficit and therefore for the total prognosis of the patient.