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Old 12-13-2012
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Arrow A 4-year-old boy with CO poisoning

A 4-year-old boy is brought to the local ED 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 uncharacteristically 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 vacationing at a nearby mountain resort noted for its “rustic log cabins with wood-burning fireplaces.” His temperature is 37°C (98.6°F), blood pressure is 90/50 mm Hg, pulse is 130/min, and respiratory rate is 26/min. The patient is minimally cooperative; he refuses to walk, preferring to nap in his mother’s arms. There is no evidence of head trauma and his physical examination is otherwise unremarkable. Further testing would likely reveal which of the following abnormalities?

(A) Blood glucose of 60 mg/dL
(B) Low partial pressure of arterial oxygen measured in arterial blood gas testing
(C) Metabolic acidosis with increased anion gap
(D) Pulmonary effusion on x-ray of the chest
(E) Pulse oximetry of 89%
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CO causes anemia like situation so hypoxia would drive the anaerobic metabolism and lead to lactic acidosis.......My answer C.....
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my best bet is C. most likely its CO poisoning if considering his symptomatology and onset of the condition in addition to his father complain.we know the ABG and oximetry will be normal. and because of hypoximia it will drive anaerobic metabolism with resultant lactic acid formation causing metabolic acidosis with increased anion gap
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(C) Metabolic acidosis with increased anion gap
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All of you are right
The correct answer is C.
Carbon monoxide poisoning should be considered in any case of headache with altered mental status. The father’s headaches may be a coincidence but should increase the index of suspicion for carbon monoxide exposure. Prolonged exposure to even low levels of carbon monoxide may produce moderate to severe poisoning. Mild exposure may result in headaches, somnolence, dizziness, and nausea. Symptoms of moderate to severe toxicity may include chest pain, dyspnea, headache, ataxia, confusion, seizures, coma, and eventually death. In severe poisoning, tissue hypoxia may cause an increased anion gap metabolic acidosis secondary to increased lactic acid production. His symptoms (loss of consciousness and difficulty walking) are concerning for more severe poisoning, and an acidosis may be present.
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CO poisoning. increased anion gap metabolic acidosis.
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(C) Metabolic acidosis with increased anion gap
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