A Silent Fate

Introduction: Carbon monoxide (CO) is an odorless, colorless, non-irritating, yet significantly toxic gas and is considered the leading cause of death by poisoning in the world. The clinical picture is variable and non-specific, ranging from mild to severe. Pediatric age range is a risk group, due to central nervous system immaturity and accelerated basal metabolism. In children, the clinical progression is more aggressive and difficult to detect than in adults.

Clinical Case: The following cases describe two siblings who were observed in a Pediatric Emergency Department.

Case 1:

A 10-year-old female, who after awakening suddenly from bitemporal headache, briefly lost consciousness but recovered within minutes. After recovering, she had an episode of vomiting. The patient’s physical examination was normal. ABG: pH 7.39, lact 1.4, COHb 25.2%.

Case 2:

A 7-year-old male, after waking to use the toilet, began having a headache and feeling dizzy with lipothymia, but recovered in minutes. The patient’s physical examination was normal. ABG: pH 7.37, lact 1.4, COHb 21.7%.

Both parents remained asymptomatic.

The diagnosis of CO intoxication was made, and the treatment protocol was fulfilled with oxygen therapy in a hyperbaric chamber. Two treatment sessions were performed, with the first treatment at 2 hours after hospital admission and the second occurring 12 hours later.Both patients were discharged 24 hours after the onset of the disease, with no associated symptomatology. Patients were instructed to follow up with a consultation with Hyperbaric Medicine at the 1st, 3rd and 6th month after the occurrence.

Conclusion: These two cases demonstrate the importance of clinical judgment to a rather linear history. Correct and timely diagnosis is essential, to ensure rapid action and minimization of possible associated complications. The coordination of the team and between several services is essential.