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J Korean Soc Emerg Med > Volume 28(5); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(5): 484-492.
일산화탄소 중독에서 초기 젖산의 측정은 카복시헤모글로빈 측정과 비교하여 어떤 임상적 의의를 가지는가?
황순곤, 진상찬, 최우익, 전재천, 김태권
계명대학교 의과대학 동산의료원 응급의학과
What is the Clinical Significance of Initial Lactate Measurement Compared to Carboxyhemoglobin Measurement in Carbon Monoxide Poisoning?
Soon-Gon Hwang, Sang-Chan Jin, Woo-Ik Choi, Jae-Cheon Jeon, Tae-Kwon Kim
Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
Correspondence  Sang-Chan Jin ,Tel: 053-250-7609, Fax: 053-250-7028, Email: jchan98@daum.net,
Received: June 28, 2017; Revised: July 3, 2017   Accepted: August 9, 2017.  Published online: October 31, 2017.
ABSTRACT
Purpose:
This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning.
Method:
We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels.
Results:
Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001).
Conclusion:
Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.
Key words: Carbon monoxide poisoning, Lactates, Carboxyhemoglobin
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