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Old 07-22-2011
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Question 5 year old boy with fatigue

A 5 year old boy is brought to the local ER by his mother because he is "not acting right". His mother, who is pregnant, reports that he seemed well last night, but this morning he was groggy and appeared "flushed". He fell over twice while walking around the house and "passed out" for 20 seconds while eating breakfast. Although he did not hit his head, he did complain of a headache. On the way to the hospital he vomited once; it was nonbloody and nonbilious. There are no sick contacts in the household, but his father awoke with an unusually severe headache this morning. The family is vacationning at a nearby by mountain resort noted for its "rustic log cabins with wood burning fireplaces". His T is 98.6F, BP 90/50, pulse 130 and RR 26. The patient is minimally cooperative; he refuses to walk, prefering to nap in his mother's arms. There is no evidence of head trauma and physical is otherwise unremarkable. Further testing would most likely reveal which of the following?

A. Blood glucose level of 60mg/dL
B. Low partial pressure of arterial oxygen measured on ABG testing
C. Metabolic acidosis with increased anion gap
D. Pulmonary effusion on x-ray
E. Pulse oximetry reading of 89%
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Old 07-22-2011
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hmmm carbonmonoxide poisoning....So Pulse oximetry below 89...since it acts like a functional anemia....
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Old 07-22-2011
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Co poisoning will have high glucose, lactate, cpk so increase lactate but i dont think anion gap so i am between B and E but i will go with E..........my answer is E
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Old 07-22-2011
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It is B. In CO poisoning, oximetry may be normal, I'n not sure why, but I have read this before...
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Old 07-22-2011
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Quote:
Originally Posted by Sadalssud View Post
It is B. In CO poisoning, oximetry may be normal, I'n not sure why, but I have read this before...
Now that i think about it...U might be true...Pulse oximetry should be good because breathing is good..Its just that oxygen cant be loaded on to the hemoglobing because of co.....anyone with a sure answer for this one...
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Old 07-23-2011
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Pulse ox will show 100%
glucose aint the answer its CO poisining
effusion isnt a presentation of CO poisin
So for me its between B and C
Il choose C as i know in CO poision there will be a buildup of lactic acid ( dec O2 release = aneraobic = inc lactic acid = metabolic acidosis)

as for B i think the Oxygen is there its just not being released to the tissues hence the partial pressure should be normal , this is just a guess though so would like some confirmation.
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Old 07-23-2011
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http://www.slideshare.net/fergua/abg-interpretation

check slide # 28 this seems to say PaO2 should be normal in CO poisoning
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Old 07-23-2011
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The correct answer is C. CO poisoning should be considered in any case of headache with mental status changes . The father's headaches may be a coincidence, but should increase the index of suspicion. Children are especially at high risk due to their increase respiratory rate and minute volume.
In severe poisoning tissue hypoxia may cause an increased anion gap metabolic acidosis due to increased lactic acidosis.
Conventional pulse oximeters can only differentiate between oxyhemoglobin from deoxyhemoglobin. Carboxyhemoglobin and Methemoglobin are MISINTERPRETATED as oxygenated hemoglobin; therefore results on pulse oximeter will most likely appear normal even in presence of severe hypoxia.
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Internal-Medicine-, Pediatrics-, Step-2-Questions, Toxicology-

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