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

INTRODUCTION: To make a retrospective descriptive analysis of children with acute carbon monoxide intoxication and to present two patients with rare neuroradiological findings.
METHODS: We identified and reviewed the medical records of pediatric patients diagnosed with acute carbon monoxide (CO) intoxication and 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± 4.8years. Improperly vented coalor wood stoves was the most common (80.7%) cause of intoxication. The most common presenting symptom was nausea/vomiting and headache. Seizure was 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 326 patients ( 30.7%) also were treated with hyperbaric oxygen therapy (HBOT) as indicated by signs and symptoms or COHb levels. Brain imaging was performed in 19 patients (thirteen magnetic resonance imaging and six CT), 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.
DISCUSSION AND 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 beused safely in children.In adition, we believe that a combined treatment regime consisting of pulse methylprednisolone and HBO treatment might have should be tested as a more therapeutic potential for preventing neuronal damage in selected pediatric patients with CO poisoning.