Clinical Characteristics and Neurological Findings of Pediatric Patients with Acute Carbon Monoxide Intoxication

Abstract

Aim:The aim of this study is to analyze children with acute carbon monoxide (CO) poisoning and to present two patients with rare neuroradiological findings.Materials and Methods:We identified and reviewed the medical records of pediatric patients diagnosed with acute CO intoxication who were hospitalized in our department during a 10-year period. Epidemiologic and clinical data were collected and analyzed.Results:A total of 326 children (166 girls, 160 boys; age range 1 to 17.8 years) with CO poisoning were identified. Their ages ranged from 1 to 17.8 years, with a mean of 8.3±4.8 years. Improperly vented coal or wood stoves were the most common (80.7%) cause of intoxication. The most common presenting symptoms were nausea/vomiting and headache. Seizure was seen in 32 patients (9.8%). Two patients died and the mortality was 0.6%. All patients received normobaric oxygen therapy until their carboxyhemoglobin (COHb) levels were decreased below 2% and their symptoms resolved. One hundred of the 326 patients (30.7%) also were treated with hyperbaric oxygen (HBO) therapy as indicated by the signs and symptoms or COHb levels. Brain imaging was performed in 19 patients (thirteen magnetic resonance imaging and six computerized tomography), and was normal in 15. Acute brain stem demyelination related to water pipe smoking developed in one patient. All patients showed complete recovery without neurological sequelae except one who had mild right hemiparesis at discharge.Conclusion:Acute CO intoxication is an important health problem in our country, especially in winter, because of poorly functioning heating systems. The clinical spectrum including neurological findings varies during childhood. We suggest that HBO therapy could be used safely in children. We believe that the combined administration of pulse methylprednisolone and HBO treatment might reduce cerebral damage caused by CO poisoning in selected pediatric patients.

Keywords

• acute carbon monoxide intoxication
• clinical features
• neurological findings
• children