Case no.

5
An elderly couple is taken by ambulance to the emergency department
after their son noticed that they were both acting “strangely”. The couple had
been in good health prior to the weekend. their son usually visits or calls them
daily, but bacause of a terrible blizzard was not able to make it to their house.
They had been snowed in at their house until the snowplows cleared the roads.
they had plenty of food and were kept warm by a furnace and blankets. when
the son was able to see them for the first time in 2 days, he noticed that they
both were complaining of bad headches, confusion, fatigue and some
nausea. On arrival to the emergency department, both patients were afebrie
with normal vital signs and O2 saturation of 99% on 2L of O2 by nasal
cannula. their lips appeared to be very red. Both patients were slighly
confused but otherwise oriented. The physical examinations were within normal
limits. Carboxyhemoglobin levels were drawn and were elevated.
Learning Objectives
1.Describe the transport of electrons from the Kreb’s Cycle into the
electron transport chain and its transfer to oxygen.
2.State the two primary effects of carbon monoxide poisoning.
Discuss how carbon monoxide disrupts oxygen transport and
uncouples the electron transport chain.
3.State the diagnosis of the case and discuss its bases.
4.Discuss the pathophysiology mechanisms behind the
manifestation of the patients.
5.State the laboratory test/procedure utilized in the diagnosis of this
disease.
6.Discuss the management and prognosis of this disease.
 Descibe the Transport of Electrons
from Kreb's Cycle into the Electron Transport
Chain and its transfer to Oxygen
• Is the final pathway
where oxidative
metabolism of
carbohydrates, fatty
acids, and amino acids
converge, their carbon
skeletons converted to
CO2.
• Occurs in the
mitochondria
• Provides building blocks
of some amino acids and
supplies intermediate
substances for some
important synthetic
functions.
•located in the inner mitochondrial
membrane
•The mitochondrion contains an outer
and an inner membrane separated by
the intermembrane space. The outer
membrane contains special channels,
making it freely permeable to most
ions and small molecules, the inner
membrane is a specialized structure
that is impermeable to most small
ions, It also is highly convoluted. The
convolutions, called cristae, serve to
greatly increase the surface area of
the inner membrane.
•The matrix of the mitochondrion is
gel-like solution in the interior of the
mitochondria and is rich in protein.
 2.State the two primary effects of
carbon monoxide poisoning. Discuss how carbon
monoxide disrupts oxygen transport and uncouples
the electron transport chain.
1. Exposure to moderate
and high levels of CO over
long periods of time has also
been linked with increased
risk of heart disease.
2. Neurological and affective
sequelae
State and discuss the diagnosis and its
basis
 Carbon Monoxide Poisoning
• occurs when carbon monoxide
builds up in the bloodstream.
• The symptoms and lab result
also point outs to carbon
monoxide poisoning which is
bad headaches, confusion,
fatigue and nausea. Their
carboxyhemoglobin levels were
also elevated.
• In the case it was stated that the
two elderly couple were stuck in
their house for two days with the
burning furnace since hence the
fumes from the furnace could be
the source of the carbon
monoxide formation.
 Discuss the pathophysiology
mechanisms behind the manifestation of the
patients.
• CO gas is readily absorbed and
is unchanged by the lungs.
Cardiac injury has been
associated with hypoxia in
human and animal studies, and
it has been reported that
neurological and perivascular
injuries were hypoxic as result
of oxidative stress
(reoxygenation) secondary to
CO exposure. Damage to
central nervous system (CNS)
as result of hypoxia may lead to
cardiovascular insufficiency,
and effect of high doses of CO
on smooth muscle may result in
hypotension.
 State the laboratory test/procedure
utilized in the diagnosis of this disease.
 Carbon Monoxide Poisoning
• The key to confirming the
diagnosis is measuring the
patient’s carboxyhemoglobin
(COHgb) level.
• Other testing, such as a
fingerstick blood sugar,
alcohol and toxicology
screen, head CT scan or
lumbar puncture may be
needed to exclude other
causes of altered mental
status when the diagnosis of
carbon monoxide poisoning
is inconclusive.
 Discuss the management and
prognosis of this disease.
• Hyperbaric Chamber
• fresh air
• breathing pure oxygen
• HBOT (Hyperbaric Oxygen Theraphy)

• Improved techniques in resuscitation

and artificial life support have resulted
in greater numbers of patients
surviving with variable degrees of
brain injury. The evolution of
hypothermic treatment for comatose
survivors of cardiac arrest has
furthered the potential to improve
neurologic morbidity and lessen
mortality.
THANK YOU!