Escenarios de exposición a monóxido de carbono que orientan la sospecha clínica de intoxicación aguda

Abstract

Carbon monoxide accumulates in closed environments when there is unnoticed combustion. Signs of poisoning are non-specific, and thus circumstances around poisoning may constitute a diagnostic guide.Objective: to strengthen the clinical capacities to suspect and confirm carbon monoxide poisoning.Method: descriptive, transversal study of suspicious cases (patients with neurological or digestive symptoms for which an indoor combustion source is identified) who consulted at the Poisoning Center in 2017.Results: 111 cases were included in the study, 52 of which occurred in 22 episodes of collective exposure. 37 patients were under 15 years old and the percentage of children identified in collective poisoning (23/37) was significantly greater than the one representing adults. 67 cases occurred in winter, minimum average temperature being 9.3°C. The combustion equipment most frequently involved in poisoning events were gas-fired water heaters in the first place, followed by gas stoves. The most frequent initial symptom was headache. Average COHb was 14.7%. Severe cases (45/111) were significantly corelated to carbon monoxide exposure from gas-fired water heaters.Conclusions: the poisoning rate is low when compared to countries in a similar latitude, what suggests the possibility of under-diagnosis. Minimum environment temperature under 10°C, staying in spaces with combustion-based heating and the use of gas-fired water heaters were the typical poisoning scenarios. Headache is a key symptom to search for exposure. The diagnostic suspicion may be lower when it involves individual cases, mainly in children.