CO poisoning can be considered a “great mimic,” as the constellation of symptoms is often nonspecific. Without a known source of exposure or clues such as other sick contacts, the differential remains broad.
The most common presenting symptoms in children are headache and nausea. Without an exposure history, mild to moderate CO poisoning can be easily confused with a viral illness, food poisoning, or other causes of headache. In a study of children presenting to the ED with afebrile viral symptoms who were found on history to have a potential source of CO exposure, 50% of the children had elevated (> 2%) COHb levels, while 13% of children had COHb levels > 10%.49 In this series, all patients with COHb levels > 2% had symptomatic improvement with oxygen administration, suggesting CO was responsible for their presenting symptoms.
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