CO poisoning

 Q: Carbon Monoxide (CO) poisoning should be managed according to serial carboxyhemoglobin levels? (select one)

A) Yes

B) No

Answer: B

A carboxyhemoglobin level is needed to establish the diagnosis of CO poisoning but further management should be guided by patients' signs and symptoms. Carboxyhemoglobin level poorly correlates with the level of CO poisoning. Also, it fails to predict delayed neurologic sequelae (DNS), a hallmark of CO poisoning. 

It may be of importance for ICU physicians to know that arterial blood level is relatively more accurate to predict ICU mortality, though venous samples can be used in emergent situations. 

#toxicology

References:

1. Rose JJ, Wang L, Xu Q, et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med 2017; 195:596. 

2. Melley DD, Finney SJ, Elia A, Lagan AL, Quinlan GJ, Evans TW. Arterial carboxyhemoglobin level and outcome in critically ill patients. Crit Care Med. 2007 Aug;35(8):1882-7. doi: 10.1097/01.CCM.0000275268.94404.43. PMID: 17568332.