A Suspected Case of Carbon Monoxide Poisoning Consistent with Fentanyl Toxicity.

Abstract

A 28-year-old male with a history of marijuana use presented to an outside hospital with acute bilateral hearing loss, confusion, bleeding from the mouth, and inability to stand. Cardiac troponin (cTn) I was 3.55 ng/mL (<0.05 ng/mL), and B-natriuretic peptide (BNP) was 197 pg/mL (<100 pg/mL). Conversely, the electrocardiogram scans showed no evidence of ischemic or injury pattern, and chest X-rays were unremarkable, decreasing the probability of acute coronary syndrome. Drugs of abuse were suspected, and urine drug testing by immunoassay was ordered. At the admission hospital, immunoassay urine drug screen results were negative for amphetamines, barbiturates, benzodiazepines, tetrahydrocannabinol, cocaine, methadone, phencyclidine, and opiates. It should also be noted that no opioids/opiates, including fentanyl, were administered at the admission hospital. Aspartate aminotransferase (AST) was 2444 U/L (13–62 U/L), and alanine transaminase (ALT) was 1959 U/L (8–70 U/L). The uric acid level was 11.1 mg/dL (3.5–7.2 mg/dL), blood urea nitrogen was 36 mg/dL (7–22 mg/dL), creatinine was 4.05 mg/dL (0.60–1.30 mg/dL), and creatinine kinase was 48 073 U/L (63–473 U/L). His white blood cell count was high at 10.8 K/µL (4.16–9.95 K/µL), with a high automated neutrophil percentage of 89%. Venous blood gas pH was 7.36 (7.30–7.40), pO2 was 26 mmHg (30–40 mmHg), pCO2 was 44 mmHg (41–51 mmHg), and HCO3 25 mEq/L (23.0–31.0 mmol/L).