Case history
Case history
A 65-year-old man with a 4-hour history of progressive headache, vomiting, and dizziness is brought to the emergency room by his wife, who has also been having similar symptoms. Before presentation to the emergency room she found him to be confused. On examination, the man is awake, appears confused, and has difficulty walking due to generalized weakness and impaired balance.
Other presentations
Other, more severe clinical presentations of CO poisoning include coma, cardiogenic shock, and death. One-third to one-half of moderately and severely CO poisoned patients will have either myocardial injury or ventricular dysfunction. Patients who are unconscious and found in a fixed position can suffer from rhabdomyolysis and acute renal failure. Intentional poisoning can be associated with concomitant toxidromes from overdose.[3] Other presentations include nonspecific symptoms mimicking viral illness such as nausea and vomiting, although fever and other symptoms of infection are usually absent. Fire-related CO can be associated with significant inhalational injuries, burns, and cyanide poisoning.[4][5]
Delayed effects can be seen up to 6 weeks after exposure and include confusion, ataxia, hallucinations, and motor and gait disturbances.[4] Long-term exposure to low levels of CO can cause anorexia, personality disorders, acceleration of atherosclerosis, and polycythemia and cardiomegaly due to chronic hypoxia.[6] Even mild symptoms in a pregnant woman can have devastating effects on the unborn child, including growth retardation, congenital malformations, fetal demise, and sudden infant death.[7]
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