Review of Various Chemical Biomarkers and Scoring Systems in the Outcome Prediction of Acute Carbon Monoxide Induced Neurotoxicity and Cardiotoxicity

Document Type : Review Articles

Authors

1 Clinical Toxicology Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University

2 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Zagazig University, Egypt

3 Forensic Medicine and Clinical Toxicology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

Abstract

Background: Carbon monoxide (CO) poisoning is one of the most common fatal poisoning worldwide. CO poisoning is known to have several complications and high fatality rate. Cardiac dysfunction including arrhythmias and myocardial ischemia have often been reported in CO poisoning; scattered punctiform hemorrhages throughout the heart have been documented in autopsy samples. Whilst it is one of the most common lethal poisonings, neurological or psychiatric sequelae occurs in up to 67% of survivors. This suggests that CO is implicated in neuronal death, or loss of function of the cells in the central nervous system. Approximately half of those who survive severe CO poisoning develop delayed neurological sequelae (DNS) after a latency period of 2–40 days, with varied clinical manifestations, persistent neuropsychological effects, and no guarantee of complete recovery. However, they are potentially preventable if they are early recognized and adequately treated.

Conclusion: Prediction of complications in CO poisoned patients is believed to be a challenging task. Laboratory parameters and imaging studies have been used to predict late cardiac and neurological complications in CO poisoned patients. Many physiologic scoring systems are demonstrated as effective predictors of outcomes for patients in the emergency department. However, very few studies have applied scoring systems as predictors of CO poisoning outcome.

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