Case Study: Carbon Monoxide Poisoning

Scenario/Summary
Adam and his family decided to take a trip to the mountains for the weekend in late February. They had a small cabin and looked forward to a weekend away from the big city. The family had a wonderful time together on Saturday morning, hiking in the woods and enjoying nature. However, a storm rolled in Saturday afternoon, bringing snow and subfreezing temperatures.

Since the heater in the cabin wasn’t working well, Adam’s mother and sister decided to drive to the nearest town to spend the night. Adam and his father, not being sissies, stayed at the cabin, where they started a gas heater to keep them warm.

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The following day Adam’s mother and sister returned to find both Adam and his father unconscious. An ambulance was called, and they were transported to the nearest hospital. Adam had arterial blood gases drawn with the following results:

pH 7.2
PaCO2 31.4,
PaO2 40.7 mmHg
His oxygen saturation was 72%. Adam was diagnosed with carbon monoxide poisoning.

Deliverables
Answer the following questions and save your responses in a Microsoft Word document. Provide a scholarly resource to support your answers.

1. Concerning hemoglobin loading, please explain the relationship between oxygen (O2) and carbon monoxide (CO) binding to the hemoglobin molecules.
2. A pulse oximeter showed 100% O2 saturation during the ambulance ride. Why is that different from the 72% measured at the hospital?
3. One course of treatment is hyperbaric oxygen treatment. How does a hyperbaric chamber work?
4. Adam’s blood work shows him to be in acidosis (normal blood pH is 7.35-7.45). Explain how this will shift the hemoglobin dissociation curve and why.

 

Sample Answer

 

Case Study: Carbon Monoxide Poisoning

Relationship between oxygen (O2) and carbon monoxide (CO) binding to the hemoglobin molecules

Hemoglobin has a higher affinity to carbon monoxide than oxygen molecules combined with carbon monoxide. According to Dunn, Mythen & Grocott (2016), hemoglobin binds to carbon monoxide 200 times more than oxygen. The combinations of the two compounds lead to the formation of carboxyhemoglobin due to the competition with the substrate site. Due to the irreversibility of the carboxyhemoglobin, there is a reduction of the loading capacity, and it is difficult for hemoglobin to release oxygen in the tissues. Thus, a low level of oxygen is transported to various parts of the body.

Differences in pulse oximeter Reading

A pulse oximeter utilizes red light beams and infrared light beams to affect the detection of oxygen levels in the blood. The oximeter only detects the amount of hemoglobin saturation but does not show the differences in the two compounds, oxyhemoglobin, and carboxyhemoglobin. Carboxyhemoglobin offered false oxygen saturation to the measurement in the ambulance rise (Gottlieb et al., 2022). On the contrary, the arterial blood analysis in the hospital offered an accurate reading of the oxygen level in the blood.

How hyperbaric oxygen Chamber Works

Hyperbaric oxygen treatment speeds up the healing of carbon monoxide poisoning. The hyperbaric chamber works to raise the pressure of oxygen three times higher than the normal pressure. As a result, the lungs are forced to operate under a higher oxygen concentration than the normal levels. Therefore, the lungs carry more than expected (Maffei, 2020). The increase in the oxygen level in the blood tissues leads to a higher energy that assists the white blood cells in fighting intruding pathogens.

The shift of hemoglobin dissociation curve

The oxygen-hemoglobin dissociation shifts to the right due to the decrease in the pH level to 7.2. In this case, the hemoglobin has less affinity, and higher partial pressure of oxygen (PO2) is necessary for more oxygen binding, as illustrated by Bohr Effect9 (Benner et al., 2018). In Adam’s case, the resulting hemoglobin is deoxygenated. While more hydrogen ions combine with amino acid substrates for hemoglobin, oxygen has a lower affinity. The increase in the hydrogen ions is the reason for the decrease in the blood pH, and thus the curve shifts to the right.

 

 

 

 

 

 

 

 

References

Benner, A., Patel, A. K., Singh, K., & Dua, A. (2018). Physiology, Bohr Effect. https://europepmc.org/article/nbk/nbk526028

Dunn, J. O., Mythen, M. G., & Grocott, M. P. (2016). Physiology of oxygen transport. Baja Education16(10), 341–348.

Gottlieb, E. R., Ziegler, J., Morley, K., Rush, B., & Celi, L. A. (2022). Assessment of racial and ethnic differences in oxygen supplementation among patients in the intensive care unit. JAMA Internal Medicine182(8), 849-858.

Maffei,  (2020). Hyperbaric oxygen treatment for carbon monoxide poisoning in Italy: retrospective validation of a data collection tool for the Italian registry of carbon monoxide poisonings (IRCOP). International journal of environmental research and public health, 17(2), 574.

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