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<< Diagnosis And Management Of Carbon Monoxide Poisoning In The Emergency Department

Differential Diagnosis

The most common presenting complaint in mild to moderate CO poisoning is headache.16 Other symptoms at presentation may include myalgias, malaise, nausea, vomiting, and dizziness. (See Table 1.) It is easy to see how the exposure history is critical in mild-to-moderate cases that can easily be mistaken for tension or other benign types of headache, such as migraine. Mild presentations may also mimic gastroenteritis, influenza, or other viral syndromes, especially in children.15 In a convenience sample of 55 patients presenting in winter with flu-like symptoms to an urban ED, 13 patients (23.6%) had COHb levels greater than or equal to 10%. None of those patients was diagnosed by the treating physician as having subacute CO poisoning.17 Carbon monoxide poisoning should always be considered when groups of patients present to the ED from a single event, household, or location with similar symptoms.



Patients who present to the ED saying that they inhaled smoke, fumes, or gases may have been exposed to other harmful products of combustion in addition to CO. These compounds, their sources, and their effects are summarized in Table 2.



Because severely poisoned patients present with symptoms of major end-organ dysfunction such as coma, altered mental status, and angina pectoris, the differential diagnosis is broad. The history of exposure is critical to avoid missing this time-sensitive diagnosis by pursuing a broad evaluation (such as for coma). The prehospital care provider report is essential in this regard.

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Last Modified: 11/23/2017
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