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Nah S, Choi S, Kim GW, Moon JE, Lee YH, Han S. Prediction of delayed neuropsychiatric sequelae after carbon monoxide poisoning via serial determination of serum neuron-specific enolase levels. Hum Exp Toxicol 2021; 40:S339-S346. [PMID: 34533065 DOI: 10.1177/09603271211043475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neuron-specific enolase (NSE) is released into serum when nerve cells are damaged, and the levels thereof are used to determine neurological prognosis in patients who have suffered cardiac arrest or stroke. Delayed neuropsychiatric sequelae (DNS), a major complication of carbon monoxide poisoning (COP), can be caused by inflammatory response which is a mechanism of neuronal injury in cardiac arrest and stroke. NSE is known as a predictor of neurological prognosis in ischemic brain injury after cardiac arrest, and it is also reported as a predictor of DNS in acute COP. When serum NSE is measured serially in cardiac arrest patients, the best time to predict neurological prognosis is known at 48-72 h, but there are no studies analyzing serial serum NSE in acute COP. Thus, we explored whether serum NSE levels measured three times at 24 h intervals after COP predicted the development of DNS. METHODS This prospective observational study was conducted on patients treated for COP from May 2018 to April 2020 in a tertiary care hospital in Korea. Neuron-specific enolase levels were assessed 24, 48, and 72 h after presentation at hospital. We used logistic regression to explore the association between NSE levels and DNS development. RESULTS The NSE level was highest at 48 h, and the difference between the DNS group and the non-DNS group was greatest on the same time point. On multivariable logistic regression analysis, the NSE level at 48 h of >20.98 ng/mL (odds ratio [OR], 3.570; 95% confidence interval [CI], 1.412-9.026; P = .007) and the initial Glasgow Coma Scale (GCS) score of <9 (OR, 4.559; 95% CI, 1.658-0.12.540; P = .003) was statistically significant for DNS development. CONCLUSION Early identification of those who will experience DNS in acute COP patients is clinically important for deciding treatment. In this study, we revealed that NSE level of >20.98 ng/mL at 48 h time point can be used as an independent predictor of DNS (OR, 3.570; 95% CI, 1.412-9.026; P = .007; AUC, 0.648).
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Affiliation(s)
- Sangun Nah
- Department of Emergency Medicine, 26730Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, 26730Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, 26730Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Ji Eun Moon
- Department of Biostatistics, Clinical Trial Center, 26730Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, 26730Soonchunhyang University Hospital Bucheon, Bucheon, Korea
| | - Sangsoo Han
- Department of Emergency Medicine, 26730Soonchunhyang University Hospital Bucheon, Bucheon, Korea
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Hafez AS, El-Sarnagawy GN. S-100β in predicting the need of hyperbaric oxygen in CO-induced delayed neurological sequels. Hum Exp Toxicol 2019; 39:614-623. [PMID: 31885284 DOI: 10.1177/0960327119897104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delayed neurological sequels (DNS) have been described after carbon monoxide (CO) poisoning. There is a need to find a new prognostic marker to guide the use of hyperbaric oxygen (HBO) therapy. AIM To evaluate serum S-100β level in patients presenting with acute CO poisoning as an indicator of poisoning severity and predictor of DNS occurrence and HBO need in those patients. METHODS This prospective cohort study included patients with acute CO poisoning. On admission, carboxyhemoglobin (COHb) and S-100β levels were measured. Patients were followed up for 6 months for signs of DNS. RESULTS Out of 50 patients, 6 only developed DNS. The mean of S-100β levels was significantly higher in patients with severe poisoning and those with DNS. Receiver operating characteristic curve analysis revealed that S-100β had an area under the curve 0. 871; at a cutoff value ≥ 0.67 µg/L, its sensitivity and specificity were 100% and 77.3%, respectively. The sensitivity of S-100β was significantly higher than that of COHb, while its specificity and overall accuracy were significantly higher than those of HBO criteria. CONCLUSION Serum S-100β level on admission could be a marker of poisoning severity and a predictor of CO-induced DNS development that guides the use of HBO therapy.
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Affiliation(s)
- Amal Saf Hafez
- Department of Forensic Medicine and Clinical Toxicology, Tanta Faculty of Medicine, Tanta University, Gharbia, Egypt
| | - Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Tanta Faculty of Medicine, Tanta University, Gharbia, Egypt
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Kim H, Choi S, Park E, Yoon E, Min Y, Lampotang S. Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6. Clin Exp Emerg Med 2018; 5:185-191. [PMID: 30269454 PMCID: PMC6166038 DOI: 10.15441/ceem.17.217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/29/2017] [Indexed: 12/15/2022] Open
Abstract
Objective Reliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning. Methods Retrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning. Results Of a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×105; 95% CI, 4.56×102 to 9.00×1010] in model 1, [AOR, 3.69×105; 95% CI, 2.49×102 to 2.71×1011] in model 2) were independently associated with DNS development. Conclusion Based on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.
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Affiliation(s)
- Hyukhoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sangchun Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.,Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, FL, USA
| | - Eunjung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Eunhui Yoon
- Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, FL, USA
| | - Younggi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Samsun Lampotang
- Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, FL, USA
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Moon JM, Chun BJ, Lee SD, Jung EJ. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clin Toxicol (Phila) 2017; 56:751-758. [PMID: 29239210 DOI: 10.1080/15563650.2017.1415347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to investigate whether clinical parameters and serum neuron-specific enolase (NSE) levels measured at emergency department (ED) presentation help stratify the risk of acute or delayed persistent severe neurological sequelae after acute carbon monoxide (CO) poisoning induced by charcoal burning. METHODS This retrospective study included 236 patients who suffered from CO poisoning. Demographic information, serum NSE levels measured in the ED, treatment, clinical course, and long-term neurological outcomes were recorded. RESULTS The median serum NSE level at presentation was 15.5 (10.9-22.7) ng/mL. No differences were observed in the duration of CO exposure; the initial Glasgow Coma Scale (GCS) score; the levels of arterial HCO3-, white blood cells (WBCs), C-reactive protein (CRP) or troponin I; or the frequency of abnormal diffusion-weighted imaging finding at presentation among the groups with different serum NSE levels at presentation. The incidences of acute and delayed persistent neurologic sequelae assessed at 22.3 months after acute charcoal CO poisoning were 5.1% and 8.5%, respectively. No difference in the NSE level was observed between patients stratified according to long-term neurological status. According to the multinomial logistic regression analysis, age, serum CRP levels and the initial GCS score were risk factors for the two types of persistent severe neurological sequelae, whereas troponin I levels were associated only with the acute persistent severe neurological sequelae. However, the adjusted NSE level was not a risk factor for any persistent neurological sequelae. CONCLUSIONS Serum NSE levels at presentation were not correlated with the risk of acute or delayed persistent neurological sequelae. Further studies with blood sampling at optimal time points and serial measurements should be conducted. Age, initial GCS score, and CRP levels may be risk factors for persistent severe neurological sequelae.
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Affiliation(s)
- J M Moon
- a Department of Emergency Medicine , Chonnam National University Medical School , Gwangju , South Korea
| | - B J Chun
- a Department of Emergency Medicine , Chonnam National University Medical School , Gwangju , South Korea
| | - S D Lee
- a Department of Emergency Medicine , Chonnam National University Medical School , Gwangju , South Korea
| | - E J Jung
- a Department of Emergency Medicine , Chonnam National University Medical School , Gwangju , South Korea
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Cha YS, Kim H, Do HH, Kim HI, Kim OH, Cha KC, Lee KH, Hwang SO. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol 2017; 37:240-246. [PMID: 28349731 DOI: 10.1177/0960327117698544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). To date, there have been no studies on the utility of serum neuron-specific enolase (NSE), a marker of neuronal cell damage, as a predictive marker of DNS in acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 9-month period. Serum NSE was measured after emergency department arrival, and patients were divided into two groups. The DNS group comprised patients with delayed sequelae, while the non-DNS group included patients with none of these sequelae. A total of 98 patients with acute CO poisoning were enrolled in this study. DNS developed in eight patients. The median NSE value was significantly higher in the DNS group than in the non-DNS group. There was a statistical difference between the non-DNS group and the DNS group in terms of CO exposure time, Glasgow Coma Scale (GCS), loss of consciousness, creatinine kinase, and troponin I. GCS and NSE were the early predictors of development of DNS. The area under the curve according to the receiver operating characteristic curves of GCS, serum NSE, and GCS combined with serum NSE were 0.922, 0.836, and 0.969, respectively. In conclusion, initial GCS and NSE served as early predictors of development of DNS. Also, NSE might be a useful additional parameter that could improve the prediction accuracy of initial GCS.
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Affiliation(s)
- Y S Cha
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - H Kim
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - H H Do
- 2 Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - H I Kim
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - O H Kim
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - K-C Cha
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - K H Lee
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - S O Hwang
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Liu H, Zhang Y, Ren YB, Kang J, Xing J, Qi QH, Gao DN, Ma T, Liu XW, Liu Z. Serum S100B level may be correlated with carbon monoxide poisoning. Int Immunopharmacol 2015; 27:69-75. [PMID: 25925764 DOI: 10.1016/j.intimp.2015.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/01/2015] [Accepted: 04/15/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the correlation between serum S100B level and carbon monoxide (CO) poisoning by meta-analysis. METHODS By searching both English and Chinese language-based electronic databases (PubMed, EBSCO, Ovid, Springerlink, Wiley, Web of Science, Wanfang databases, China national knowledge infrastructure (CNKI), VIP database, etc.) thoroughly, we tabulated and analyzed the collected data with the use of Comprehensive Meta-analysis 2.0 (CMA 2.0). RESULTS Totally 108 studies have been searched initially (92 studies in Chinese, 16 studies in English). Nine case-control studies (4 studies in English, 5 in Chinese) were chosen for an updated meta-analysis including 542 patients with CO poising and 236 healthy controls. Results identified that the serum S100B level were obviously higher than that in healthy controls (SMD=1.600, 95% CI=1.055-2.145, P<0.001). A subgroup based on the ethnicities revealed that the serum S100B level in Caucasian and Asian subgroups was clearly higher than serum S100B level in healthy controls (Asians: SMD=2.0624, 95% CI=1.736-3.511, P<0.001; Caucasians: SMD=0.447, 95% CI=0.197-0.697, P<0.001). CONCLUSION Serum S100B level may be correlated with the CO poisoning and could be effective biomarker for early diagnosis and treatment monitoring in CO poisoning.
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Affiliation(s)
- Hui Liu
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China
| | - Yu Zhang
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China
| | - Yan-Bo Ren
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China
| | - Jian Kang
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China
| | - Jing Xing
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China
| | - Qing-Hui Qi
- Department of Abdominal Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China
| | - Dong-Na Gao
- Department of Emergency, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, PR China.
| | - Tao Ma
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang 110001, PR China
| | - Xiao-Wei Liu
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang 110001, PR China
| | - Zhi Liu
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang 110001, PR China
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Abstract
Carbon monoxide (CO) is a colorless, odorless, nonirritant gas that accounts for numerous cases of CO poisoning every year from a variety of sources of incomplete combustion of hydrocarbons. These include poorly functioning heating systems, indoor propane-powered forklifts, indoor burning of charcoal burning briquettes, riding in the back of pick-up trucks, ice skating rinks using propane-powered resurfacing machines, and gasoline-powered generators that are not in correct locations. Once CO is inhaled it binds with hemoglobin to form carboxyhemoglobin (COHb) with an affinity 200 times greater than oxygen that leads to decreased oxygen-carrying capacity and decreased release of oxygen to tissues leading to tissue hypoxia. Ischemia occurs with CO poisoning when there is loss of consciousness that is accompanied by hypotension and ischemia in the arterial border zones of the brain. Besides binding to many heme-containing proteins, CO disrupts oxidative metabolism leading to the formation of free radicals. Once hypotension and unconsciousness occur with CO poisoning, lipid peroxidation and apoptosis follow. Because COHb has a short half-life, examination of other biomarkers of CO neurotoxicity that reflect inflammation or neuronal damage has not demonstrated consistent results. The initial symptoms with CO exposure when COHb is 15-30% are nonspecific, namely, headache, dizziness, nausea, fatigue, and impaired manual dexterity. However individuals with ischemic heart disease may experience chest pain and decreased exercise duration at COHb levels between 1% and 9%. COHb levels between 30% and 70% lead to loss of consciousness and eventually death. Following resolution of acute symptoms there may be a lucid interval of 2-40 days before the development of delayed neurologic sequelae (DNS), with diffuse demyelination in the brain accompanied by lethargy, behavior changes, forgetfulness, memory loss, and parkinsonian features. Seventy-five percent of patients with DNS recover within 1 year. Neuropsychologic abnormalities with chronic CO exposure are found even when magnetic resonance imaging (MRI) and magnetic resonance spectroscopy are normal. White-matter damage in the centrum semiovale and periventricular area and abnormalities in the globus pallidus are most commonly seen on MRI following CO exposure. Though not as common, toxic or ischemic peripheral neuropathies are associated with CO exposure in humans and animals. The cornerstone for treatment for CO poisoning is 100% oxygen using a tight-fitting mask for greater than 6 hours. The indications for treatment with hyperbaric oxygen to decrease the half-life of COHb remain controversial.
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Affiliation(s)
- Margit L Bleecker
- Center for Occupational and Environmental Neurology, Baltimore, MD, USA.
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Gawlikowski T, Golasik M, Gomółka E, Piekoszewski W. Proteins as biomarkers of carbon monoxide neurotoxicity. Inhal Toxicol 2014; 26:885-90. [DOI: 10.3109/08958378.2014.970786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pang L, Wang HL, Wang ZH, Wu Y, Dong N, Xu DH, Wang DW, Xu H, Zhang N. Plasma copeptin as a predictor of intoxication severity and delayed neurological sequelae in acute carbon monoxide poisoning. Peptides 2014; 59:89-93. [PMID: 25038511 DOI: 10.1016/j.peptides.2014.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Abstract
The present study was designed to assess the usefulness of measuring plasma levels of copeptin (a peptide co-released with the hypothalamic stress hormone vasopressin) as a biomarker for the severity of carbon monoxide (CO) poisoning and for predicting delayed neurological sequelae (DNS). Seventy-two patients with CO poisoning and 72 sex and age matched healthy individuals were recruited. Plasma copeptin levels were measured on admission from CO poisoning patients and for healthy individuals at study entry by using a sandwich immunoassay. The CO poisoning patients were divided into two groups according to severity (unconscious and conscious) and occurrence of DNS. The mean plasma copeptin levels (52.5±18.5 pmol/L) in the unconscious group were significantly higher than in the conscious group (26.3±12.7 pmol/L) (P<0.001). Plasma copeptin levels of more than 39.0 pmol/L detected CO poisoning with severe neurological symptoms e.g. unconsciousness (sensitivity 84.6% and specificity 81.4%). The plasma copeptin levels were higher in patients with DNS compared to patients without DNS (52.2±20.6 pmol/L vs. 27.9±14.8 pmol/L, P<0.001). Plasma copeptin levels higher than 40.5 pmol/L predicted the development of DNS (sensitivity 77.8%, specificity 82.1%). Plasma copeptin levels were identified as an independent predictor for intoxication severity [odds ratio (OR) 1.261, 95% confidence interval (CI) 1.112-1.638, P=0.002] and DNS (OR 1.313, 95% CI 1.106-1.859, P=0.001). Thus, plasma copeptin levels independently related to intoxication severity and were identified as a novel biomarker for predicting DNS after acute CO poisoning.
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Affiliation(s)
- Li Pang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - He-Lei Wang
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - Zhi-Hao Wang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - Yang Wu
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - Ning Dong
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - Da-Hai Xu
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - Da-Wei Wang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China
| | - Hong Xu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China.
| | - Nan Zhang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Road, Changchun 130021, China.
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Park EJ, Min YG, Kim GW, Cho JP, Maeng WJ, Choi SC. Pathophysiology of brain injuries in acute carbon monoxide poisoning: A novel hypothesis. Med Hypotheses 2014; 83:186-9. [DOI: 10.1016/j.mehy.2014.04.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/19/2014] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
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Akdemir HU, Yardan T, Kati C, Duran L, Alacam H, Yavuz Y, Okuyucu A. The role of S100B protein, neuron-specific enolase, and glial fibrillary acidic protein in the evaluation of hypoxic brain injury in acute carbon monoxide poisoning. Hum Exp Toxicol 2014; 33:1113-20. [PMID: 24505052 DOI: 10.1177/0960327114521049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The main purpose of this study was to assess the role of S100B protein, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP) in the evaluation of hypoxic brain injury in acute carbon monoxide (CO)-poisoned patients. This cross-sectional study was conducted among the patients with acute CO poisoning who referred to the emergency department in a 1-year period. Serum levels of S100B protein, NSE, and GFAP were determined on admission. A total of 55 CO-poisoned patients (mean age ± standard deviation, 45 ± 20.3 years; 60% women) were included in the study. The control group consisted of 25 healthy adults. The patients were divided into two groups according to whether they were conscious or unconscious. The serum levels of S100B, NSE, and GFAP were higher in patients than that in the control group. There was no significant difference between unconscious and conscious patients with respect to these markers. There was a statistically significant difference between the conscious and unconscious patients and the control group in terms of S100B and NSE levels. There was also a statistically significant difference between the unconscious patients and the control group in terms of GFAP levels. Increased serum S100B, NSE, and GFAP levels are associated with acute CO poisoning. These biomarkers can be useful in assessing the clinical status of patients with CO poisoning.
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Affiliation(s)
- H U Akdemir
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - T Yardan
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - C Kati
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - L Duran
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - H Alacam
- Department of Biochemistry, Ondokuz Mayis University, Samsun, Turkey
| | - Y Yavuz
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - A Okuyucu
- Department of Biochemistry, Ondokuz Mayis University, Samsun, Turkey
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Akelma AZ, Celik A, Ozdemir O, Kavak Akelma F, Abaci A, Razi CH, Kislal FM, Akin O. Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults. Am J Emerg Med 2013; 31:524-8. [DOI: 10.1016/j.ajem.2012.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 11/15/2022] Open
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Ghorbani M, Moallem SA, Abnous K, Tabatabaee Yazdi SA, Movassaghi AR, Azizzadeh M, Mohamadpour AH. The effect of granulocyte colony-stimulating factor administration on carbon monoxide neurotoxicity in rats. Drug Chem Toxicol 2012; 36:102-8. [DOI: 10.3109/01480545.2012.737802] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bozkurt A, Yardan T, Ciftcioglu E, Baydin A, Hakligor A, Bitigic M, Bilge S. Time course of serum S100B protein and neuron-specific enolase levels of a single dose of chlorpyrifos in rats. Basic Clin Pharmacol Toxicol 2012; 107:893-8. [PMID: 20456333 DOI: 10.1111/j.1742-7843.2010.00593.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Organophosphate (OP) compounds are a large class of chemicals, many of which are used as pesticides. It is suggested that OPs specifically affect glia and neurons. Effects of acute exposure to chlorpyrifos (CPF), which is a common organophosphorus pesticide used worldwide, on neuron-specific enolase (NSE) and S100B levels in rat blood during 7 days were assessed. Rats were evaluated either before (0 hr) or 2, 12, 24, 48 and 168 hr (7 days) after injection of CPF (279 mg/kg, s.c.) or vehicle (peanut oil, 2 ml/kg, s.c.) for clinical signs of toxicity. Immediately after the evaluation of toxicity, blood samples were taken for biochemical assays. CPF administration produced decreases in body-weight and temperature, which were observed for first time at 12 hr after CPF administration and continued for 168 hr (p < 0.05-0.001). Serum S100B and NSE levels were acutely increased 2 hr after CPF administration and remained high at 12 hr (p < 0.01-0.001). NSE and S100B levels were not different in either CPF or vehicle groups at following time points. Serum butyrylcholinesterase (EC 3.1.1.8; BuChE) activity was dramatically reduced at 2 hr after CPF and remained low at each time points during 7 days (p < 0.01-0.001). Our results suggest that the usefulness of serum levels of these glia- and neuron-specific marker proteins in assessing OP toxicity, specifically CPF-induced toxicity.
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Affiliation(s)
- Ayhan Bozkurt
- Department of Physiology, Ondokuz Mayıs University, School of Medicine, Samsun, Turkey.
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Kilicaslan I, Bildik F, Aksel G, Yavuz G, Gulbahar O, Keles A, Demircan A. Serum tau protein level for neurological injuries in carbon monoxide poisoning. Clin Toxicol (Phila) 2012; 50:497-502. [DOI: 10.3109/15563650.2012.698742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Park E, Ahn J, Min YG, Jung YS, Kim K, Lee J, Choi SC. The usefulness of the serum s100b protein for predicting delayed neurological sequelae in acute carbon monoxide poisoning. Clin Toxicol (Phila) 2012; 50:183-8. [PMID: 22372785 DOI: 10.3109/15563650.2012.658918] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Some patients with acute carbon monoxide poisoning will experience delayed neurological sequelae. Several factors associated with delayed neurological sequelae have been reported, but these factors are unsatisfactory for the assessment of unconscious patients. OBJECTIVE The aim of this study was to assess the usefulness of the serum S100B protein as a biochemical marker for predicting delayed neurological sequelae. MATERIALS AND METHODS In this retrospective study, we evaluated the data for patients who visited an emergency medical center once during a period of 7 months. The enrollment criteria were the diagnosis of acute carbon monoxide poisoning and the measurement of the serum S100B level. A standardized extraction using medical records was performed. RESULT A total of 71 patients were enrolled, and 10 patients (14.1%) presented delayed neurological sequelae. The delayed neurological sequelae group had a longer duration of carbon monoxide exposure, a longer duration of loss of consciousness, and a worse mental status (p-value < 0.001). In addition, the S100B protein levels were higher in the delayed neurological sequelae group (0.891 vs. 0.063, p-value < 0.001). Multiple logistic regression analysis showed that only the serum S100B protein level was independently associated with the development of delayed neurological sequelae (OR, 120.594; 95% CI, 4.194-3467.220), and a serum S100B protein level of more than 0.165 μg/L predicted the development of delayed neurological sequelae (sensitivity 90%, specificity 87%). DISCUSSION AND CONCLUSION In the present study, the level of serum S100B protein was found to be useful for evaluating acute CO poisoning patients and was found to be an independent predictor of the development of DNS after acute CO poisoning.
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Affiliation(s)
- Eunjung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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17
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Elevated S100B level in cerebrospinal fluid could predict poor outcome of carbon monoxide poisoning. Am J Emerg Med 2012; 30:222-5. [DOI: 10.1016/j.ajem.2010.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 11/14/2010] [Indexed: 11/20/2022] Open
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18
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Intoxication au monoxyde de carbone et place de l’oxygénothérapie hyperbare. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0327-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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19
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Moon JM, Shin MH, Chun BJ. The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Hum Exp Toxicol 2010; 30:836-43. [PMID: 20876159 DOI: 10.1177/0960327110384527] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to determine whether lactate levels were associated with the short-term outcome of patients with CO poisoning and identify the characteristics of patients with high initial lactate levels. Eighty patients that presented to the Chonnam National University Hospital after CO poisoning, over 5 years, were enrolled in this retrospective study. Fifty-six (70.0%) patients had high lactate (>2.1 mmo/L) on admission. Thirty-three (41.3%) patients had medical complications and one patient (1.3%) died. The patients with high initial lactate had an altered mental status more frequently, higher WBC, glucose and carboxyhemoglobin (COHb), and lower base deficit on admission. The multivariate analysis showed that lactate was an independent factor associated with serious complications and the need for intensive medical treatment, along with advanced age, WBC, and altered mental status on admission. The results of this study show that the initial lactate was useful for patient prognosis after CO poisoning.
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Affiliation(s)
- Jeong Mi Moon
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
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Yardan T, Meric M, Bozkurt A, Bilge S, Bas DB, Bedir A, Ozdemir T, Baydin A. The role of heart-type fatty acid-binding protein in the evaluation of carbon monoxide poisoning in rats. Hum Exp Toxicol 2010; 30:124-8. [PMID: 20375122 DOI: 10.1177/0960327110368421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute carbon monoxide (CO) poisoning can cause early and persistent damages in tissues sensitive to hypoxia. This study investigated serum heart-type fatty acid-binding protein (H-FABP) levels as a biomarker of acute CO poisoning in rats. The rats were exposed to a mixture of either 3000 (group A) or 5000 (group B) parts per million (ppm) CO in air, or to ambient air (group C, control group). Blood samples were taken just before, immediately after and 6 hours after the exposure, and serum H-FABP and troponin-I levels were measured. The consciousness level was evaluated just after the exposure. The survival rate was monitored for 7 days. Serum H-FABP levels increased just after the CO exposure in both groups A and B. Additionally, H-FABP level was higher in group B than in group A, immediately after the exposure. However, serum troponin-I levels only increased at 6 hours after the CO exposure in groups A and B. Consciousness and survival rates in group B were lower than that in group A. Our results suggest that H-FABP might have potential to be an early and quantitative parameter of clinical severity and prognosis in CO poisoning.
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Affiliation(s)
- Turker Yardan
- Department of Emergency Medicine, School of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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21
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Thom SR, Bhopale VM, Milovanova TM, Hardy KR, Logue CJ, Lambert DS, Troxel AB, Ballard K, Eisinger D. Plasma biomarkers in carbon monoxide poisoning. Clin Toxicol (Phila) 2010; 48:47-56. [PMID: 20095814 DOI: 10.3109/15563650903468209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The severity of acute carbon monoxide (CO) poisoning is often based on non-specific clinical criteria because there are no reliable laboratory markers. We hypothesized that a pattern of plasma protein values might objectively discern CO poisoning severity. This was a pilot study to evaluate protein profiles in plasma samples collected from patients at the time of initial hospital evaluation. The goal was to assess whether any values differed from age- and sex-matched controls using a commercially available plasma screening package. METHODS Frozen samples from 63 suspected CO poisoning patients categorized based on clinical signs, symptoms, and blood carboxyhemoglobin level were analyzed along with 42 age- and sex-matched controls using Luminex-based technology to determine the concentration of 180 proteins. RESULTS Significant differences from control values were found for 99 proteins in at least one of five CO poisoning groups. A complex pattern of elevations in acute phase reactants and proteins associated with inflammatory responses including chemokines/cytokines and interleukins, growth factors, hormones, and an array of auto-antibodies was found. Fourteen protein values were significantly different from control in all CO groups, including patients with nominal carboxyhemoglobin elevations and relatively brief intervals of exposure. CONCLUSIONS The data demonstrate the complexity of CO pathophysiology and support a view that exposure causes acute inflammatory events in humans. This pilot study has insufficient power to discern reliable differences among patients who develop neurological sequelae but future trials are warranted to determine whether plasma profiles predict mortality and morbidity risks of CO poisoning.
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Affiliation(s)
- Stephen R Thom
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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22
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S-100beta and neuron-specific enolase levels in carbon monoxide-related brain injury. Am J Emerg Med 2010; 28:61-7. [PMID: 20006203 DOI: 10.1016/j.ajem.2008.10.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 10/24/2008] [Accepted: 10/26/2008] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Carbon monoxide (CO) toxicity may cause persistent injuries in tissues sensitive to hypoxia. Neuropsychiatric sequelae may be observed in about 67% of cases after severe CO exposure. AIM The aims of this study were to demonstrate the usefulness of S-100beta and neuron-specific enolase (NSE) in CO intoxications, show the degree of neurological response, and determine the indications for hyperbaric oxygen treatment (HBOT) as biochemical markers. RESULTS The S-100beta and NSE levels of the sera of 30 patients were studied upon admittance and at the third and sixth hours. S-100beta levels were found to be high in all 3 analyses. There was no significant change in NSE levels. When the S-100beta levels were compared with Glasgow Coma Scale levels, a strong negative correlation was found for all hours (r = -0.7, -0.8; P = .00). The correlation between S-100beta and carboxyhemoglobin levels at the initial hour was found to be statistically significant (r = 0.4; P = .01). The S-100beta levels in patients receiving HBOT showed a considerable decrease compared with those in patients not receiving the treatment. The same decrease was valid for NSE, although it was insignificant. CONCLUSION S-100beta may be useful in evaluating intoxications as an early biochemical marker in CO intoxications, as well as in the differential diagnosis due to other causes, and in determining HBOT indications.
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The early elevation of interleukin 6 concentration in cerebrospinal fluid and delayed encephalopathy of carbon monoxide poisoning. Am J Emerg Med 2009; 27:992-6. [DOI: 10.1016/j.ajem.2008.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 07/14/2008] [Accepted: 07/15/2008] [Indexed: 11/15/2022] Open
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Yardan T, Cevik Y, Donderici O, Kavalci C, Yilmaz FM, Yilmaz G, Vural K, Yuzbasioglu Y, Gunaydin YK, Sezer AA. Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning. Am J Emerg Med 2009; 27:838-42. [PMID: 19683113 DOI: 10.1016/j.ajem.2008.04.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 03/31/2008] [Accepted: 04/15/2008] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Carbon monoxide (CO) poisoning causes cerebral and generalized hypoxia. This study aimed to assess the possible use of serum glial marker S100B protein and neuron-specific enolase (NSE) as biochemical markers of hypoxic brain damage in acute CO poisoning. METHODS Patients with acute CO poisoning admitted to the ED of 2 training hospitals (Ankara, Turkey) were included in this cross-sectional study. Serum levels of S100B and NSE were measured on admission. The patients were divided into 2 groups (unconscious and conscious). Twenty healthy adults were included in the study to serve as controls. RESULTS A total of 70 patients poisoned by CO (mean age +/- SD, 36.6 +/- 16.3 years; 64.3% women) were enrolled. Although S100B concentrations were higher in patients than in the control group (P = .018), no significant difference was determined between patient and control groups with respect to NSE concentrations (P = .801). A positive correlation was noted between levels of S100B and NSE (r = 0.388; P = .001). The S100B and NSE values were higher in unconscious patients than in the control group (P = .002 and P = .013, respectively). Furthermore, S100B and NSE values were higher in unconscious vs unconscious patients (P = .047 and P = .005, respectively). CONCLUSION Elevated serum S100B and NSE levels were associated with loss of consciousness in CO poisoning in this series of patients. Serum S100B and NSE may be useful markers in the assessment of clinical status in CO poisoning.
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Affiliation(s)
- Turker Yardan
- Faculty of Medicine, Department of Emergency Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey.
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25
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Abstract
Carbon monoxide (CO), a highly toxic gas produced by incomplete combustion of hydrocarbons, is a relatively common cause of human injury. Human toxicity is often overlooked because CO is tasteless and odorless and its clinical symptoms and signs are non specific. The brain and the heart may be severely affected after CO exposure with carboxyhemoglobin (COHb) levels exceeding 20%. Damage occurs because the affinity of hemoglobin for CO is 210 times higher than for O(2). Hypoxic brain damage predominates in the cerebral cortex, cerebral white matter and basal ganglia, especially in the globus pallidus. Diagnosis requires clinical acumen and a high index of suspicion, combined with epidemiological data, clinical examination, analysis of ambient air CO and patient COHb levels; also required are cardiology evaluation including ECG as well as neurological evaluation including brain imaging (CT and/or MRI, MR spectroscopy), and neuropsychological testing. Although immediate O(2) breathing is sometimes an adequate treatment, hyperbaric oxygen therapy (HBO) is favored. Subsequently, only symptomatic therapy is available for the long-term sequelae of CO poisoning.
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Affiliation(s)
- Leon D Prockop
- Department of Neurology, College of Medicine, University of South Florida, FL, USA.
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26
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Karalliedde L. Carbon monoxide poisoning. Int J Clin Pract 2006; 60:1523-4. [PMID: 17109660 DOI: 10.1111/j.1742-1241.2006.00961.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Brvar M, Finderle Z, Suput D, Bunc M. S100B protein in conscious carbon monoxide-poisoned rats treated with normobaric or hyperbaric oxygen. Crit Care Med 2006; 34:2228-30. [PMID: 16763504 DOI: 10.1097/01.ccm.0000228913.61710.9d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate S100B, an astroglial structural protein, during normobaric and hyperbaric oxygen therapy of conscious carbon monoxide (CO)-poisoned rats. So far, the usefulness of hyperbaric oxygen therapy in conscious CO-poisoned patients has been shown with neuropsychological testing. The S100B protein has been demonstrated as a possible biochemical marker and prognostic parameter in CO-poisoned rats. DESIGN Randomized, controlled interventional trial. SETTING University laboratory. SUBJECTS : Male Wistar rats weighing 254 +/- 14 g. INTERVENTIONS The rats were exposed to a mixture of 3,000 ppm CO in air for 60 mins. After CO exposure, the first group of eight conscious rats was exposed to ambient air for 30 mins, the second group of six conscious rats was exposed to 100% normobaric oxygen for 30 mins, and the third group of six conscious rats was exposed to 100% hyperbaric oxygen at 3 bars for 30 mins. Blood samples were taken from the jugular vein just before CO exposure and immediately after oxygen therapy. The level of consciousness was evaluated at the end of exposure, and the survival rate was monitored for 14 days. The S100B concentrations were measured with a commercial immunoluminometric assay. MEASUREMENTS AND MAIN RESULTS Analyses of differences in S100B levels between different kinds of therapy before and after treatment showed a global significant difference (p = .002). The post hoc test results showed that S100B levels after therapy of the first group treated with ambient air (0.16 +/- 0.07 microg/L) and the second group treated with normobaric oxygen (0.19 +/- 0.05 microg/L) were similar (p = .741), and both of them were significantly different, with much higher values of S100B levels after therapy, from the third group treated with hyperbaric oxygen (0.06 +/- 0.03 microg/L; p = .018 and p = .002, respectively). All the rats survived. CONCLUSIONS S100B is elevated in conscious CO-poisoned rats left on ambient air or treated with normobaric oxygen, but not in conscious CO-poisoned rats treated with hyperbaric oxygen.
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Affiliation(s)
- Miran Brvar
- Poison Control Centre, Ljubljana Medical Centre, Ljubljana, Slovenia
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28
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Abstract
Carbon monoxide is an insidious poison that accounts for thousands of deaths each year in North America. Clinical effects maybe diverse and include headache, dizziness, nausea, vomiting,syn-cope, seizures, coma, dysrhythmias, and cardiac ischemia. Children, pregnant women, and patients who have underlying cardiovascular disease are particularly at risk for adverse out-comes. Treatment consists of oxygen therapy, supportive care, and, in selected cases, hyperbaric oxygen therapy.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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29
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Abstract
CO is an ubiquitous poison with many sources of exposure. CO poisoning produces diverse signs and symptoms that are often subtle and may be easily misdiagnosed. Failure to diagnose CO poisoning may result insignificant morbidity and mortality and permit continued exposure to a dangerous environment. Treatment of CO poisoning begins with inhalation of supplemental oxygen and aggressive supportive care. HBOT accelerates dissociation of CO from hemoglobin and may also prevent DNS. Absolute indications forHBOT for CO poisoning remain controversial, although most authors would agree that HBOT is indicated in patients who are comatose or neurologically abnormal, have a history of LOC with their exposure, or have cardiac dysfunction. Pregnancy with an elevated CO-Hgb level(>15%-20%) is also widely, considered an indication for treatment.HBOT may be considered in patients who have persistent symptoms despite NBO, metabolic acidosis, abnormalities on neuropsychometric testing, or significantly elevated levels. The ideal regimen of oxygen therapy has yet to be determined, and significant controversy exists regarding HBOTtreatment protocols. Often the local medical toxicologist, poison control center, or hyperbaric unit may assist the treating physician with decisions regarding therapy.
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Affiliation(s)
- Louise W Kao
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206, USA.
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