Evaluating ECG and carboxyhemoglobin
changes due to smoking narghile.
Admission and pre-discharge control carboxyhemoglobin
levels and cardiac affect of poisoning Parameter Arrival n (%) Control n (%) COHb Normal 25 (10.8) 81 (34.9) High 207 (89.2) 151 (65.1) CK-MB Normal 112 (48.3) High 120 (51.7) Troponin Negative 204 (87.9) Positive 28 (12.1) EKG Normal 168 (72.4) Bradycardia 16 (6.9) Tachycardia 48 (20.7) Total 232 (100) COHb: Carboxyhemoglobin
, CK-MB: Creatine kinase, ECG: Electrocardiography Table 3.
Data on carboxyhemoglobin
levels were available for 19 participants.
: Sources of carbon monoxide exposure.
Table 1 Typical COHb levels in various populations Population COHb levels Nonsmokers <1% Smokers <1 % to 9% Pregnancy <5% Hemolytic anemia <5% Urban polluted areas At least 1 % higher than normal COHb: carboxyhemoglobin
Source: References 3-5 Table 2 Adverse effects of stimulants and occult CO poisoning Stimulants Occult CO poisoning Nervousness Fatigue Headache Headache Irritability Difficulty thinking Dizziness Dizziness Nausea Nausea Insomnia Insomnia Palpitations Heart pounding CO: carbon monoxide Source: References 1,2,8
Masheyi, "Methylene chloride exposure and carboxyhemoglobin
levels in cabinetmakers," Indian Journal of Occupational and Environmental Medicine, vol.
AE: Acute exacerbation ARDS: Acute respiratory distress syndrome AUC: Area under the ROC curve CO-Hb: Carboxyhemoglobin
CT-ILD: Connective tissue disease-associated ILD ELISA: Enzyme-linked immunosorbent assay Fi[O.sub.2]: Fraction of inspiratory oxygen GGO: Ground glass opacity HO-1: Hemeoxygenase-1 HRCT: High-resolution CT ICU: Intensive care unit ILD: Interstitial lung disease iNSIP: Idiopathic nonspecific interstitial pneumonia IP: Interstitial pneumonia IPF: Idiopathic pulmonary fibrosis KL-6: Krebs von den Lungen-6 LDH: Lactate dehydrogenase Pa[O.sub.2]: Partial pressure of oxygen in arterial blood ROC: Receiver operating characteristics SP: Surfactant protein.
However, 36 hours into admission, his serum creatinine inexplicably rose to 2.3 with a rise in carboxyhemoglobin
to 3.6%, while his urine output remained stable (Figure 1).
These patients consistently have elevated serum levels of nitric oxide and carboxyhemoglobin
, both of which have been postulated to play a role in the pathogenesis of the syndrome  and normalize after liver transplantation.
Consciousness disturbance upon arrival, exposure to CO for a long time (>12 hours), and elevation of arterial carboxyhemoglobin
(CO-Hb) were the major indications for HB[O.sub.2] therapy.
- South Plainfield, New Jersey-based biotechnology company Prolong Pharmaceuticals will present interim results from a Phase II trial of Sanguinate (PEGylated carboxyhemoglobin
bovine) as a poster at the American Society of Hematology (ASH) annual meeting, which will take place December 9-12, in Atlanta, Georgia, the company said.
The main pathophysiological mechanism is dependent on the capability of CO to bind to hemoglobin with a high affinity, which displaces oxygen and forms carboxyhemoglobin
(COHb), in which oxygen cannot be delivered to the cells.