Kubát K, Zboril M
Interní oddĕlení I., Litomĕrice.
Vnitr Lek. 1995 Aug;41(8):545-8.
The authors present a description of severe accidental carbon monoxide poisoning. They stress the significance of the examination of lactic acid level at this poisoning. In case described the level of carbonyl haemoglobin could not be determined because of device trouble. Patient AA (16-year-old) was admitted in relatively very good condition, without clinical signs of severer affection. Considering the facts that gas-poisoning (over 24 hrs) was found through anamnesis, and simultaneous admission of patient's greatgrandmother in critical condition, the patient AA was treated also with oxygen of high concentration, monitored, kept in absolute rest. High lactate level (18.9 mmol/l) and the evidence of metabolic acidosis (pH 7.16, pO2 8.65, pCO2 2.06, sBE -22.1) made to suspect of severe poisoning. Despite intensive oxygenotherapy it came to severe left-side cardial failure associated with pulmonal edema, anuria, shock after 4 hours, managed successfully within 4 hours. Lactate level correlated very well with condition severity. Septum hypokinesis was demonstrated cardiografically and it disappeared within 6 days. However, symetric inversion of T wave in many leads (I, II, aVF, V 2-6) persisted for 24 days. The authors assume that routine examination of acid base balance and lactate level in addition to the determination of carbonyl haemoglobin level is very important for the consideration of the severity of carbon monoxide poisoning. Lactataemia determination is probably even more significant for the assumption of oxygen deficit and therefore for the total prognosis of the patient.
作者介绍了一例严重意外一氧化碳中毒病例。他们强调了在这种中毒情况下检测乳酸水平的重要性。在所描述的病例中，由于设备故障无法测定碳氧血红蛋白水平。患者AA（16岁）入院时状况相对良好，没有严重病情的临床体征。鉴于通过问诊发现有气体中毒（超过24小时），且患者的曾祖母同时因病情危急入院，患者AA也接受了高浓度氧气治疗、监测，并保持绝对卧床休息。高乳酸水平（18.9 mmol/L）以及代谢性酸中毒的证据（pH 7.16，pO2 8.65，pCO2 2.06，sBE -22.1）使人怀疑为严重中毒。尽管进行了强化氧疗，但4小时后仍出现了严重的左侧心力衰竭，并伴有肺水肿、无尿、休克，不过在4小时内成功得到控制。乳酸水平与病情严重程度密切相关。心电图显示室间隔运动减弱，6天内消失。然而，多个导联（I、II、aVF、V2 - 6）的T波对称性倒置持续了24天。作者认为，除了测定碳氧血红蛋白水平外，常规检测酸碱平衡和乳酸水平对于评估一氧化碳中毒的严重程度非常重要。乳酸血症的测定对于判断氧缺乏情况进而对于患者的总体预后可能更为重要。
