GUESS THAT DIAGNOSIS: Headache, Cherry Red Lips, & Hallucinations

INFO ON THIS PATIENT:

QUICK OVERVIEW ABOUT PATIENT:

Patient comes in with dizziness, vomiting, headache 7/10, and some mild confusion. A family member also noted that the patient’s lips have turned an almost “cherry-like” color, over the last few hours. The patient states that they see a monkey flying around the room. They also tell you “I just feel strange..almost like I have the flu or something“. They also complain about some blurred vision. They are mildly hypotensive, tachycardia, and hypoxic. See below for further info on this patient.


MORE DETAILED INFO ABOUT PATIENT:

PHYSICAL EXAM: BP 92/60, HR 108, Temp 98.6, R 16, Pulse Ox 90% on Room air. Neuro exam is essentially normal except for some mild confusion. You notice that their lips do appear “cherry red” colored.

FAMILY HX: No hx stroke or other neurological disorders. No hx of schizophrenia

VACCINATIONS: Current, up to date. None recent

LABS & OTHER TESTS: Ammonia normal, B12 normal, TSH normal. Blood glucose 145. CBC & CMP panels do not reveal any significant abnormalities. Their Lactic acid is mildly elevated. CO-Hb level done and was 18%.

IMAGING & OTHER TESTS: CT head normal, CXR shows some mild pulmonary edema, Carotid doppler normal, EKG sinus tachycardia.

WHAT IS THE MOST LIKELY DIAGNOSIS?

ANSWER

Carbon Monoxide Poisoning

WHAT: According to CDC “CO (carbon monoxide) is found in fumes produced any time you burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges, or furnaces. CO (carbon monoxide) can build up indoors and poison people and animals who breathe it.” (2)

PHYSICAL EXAM: Sometimes neurological, almost stroke like symptoms can occur. Seizure sometimes happen as well. Some patients will have cherry-red lips, peripheral cyanosis, and retinal hemorrhages, but this is rarely seen (3)

LABS: CO-Hb is a key diagnostic test (not done very often however) Toxic effects are at 15%- 20%, Severe poisoning at 25% (1). Blood glucose might be mildly elevated. Lactic acid sometimes elevated as metabolic acidosis does occur. Creatine kinase level might be elevated, as rhabdomyolysis is a potential complication

DX TESTS: CT of head usually normal, but may see some cerebral edema. CXR may see some mild pulmonary edema. Sometimes arrhythmias on ECG-a non-specifc finding, but common. (2)

S/S: Headache (common), nausea & vomitting, flu-like sx, confusion, hallucinations, seizures, dizziness, memory disturbances, shortness of breath, agitation, blurred vision, fainting, sometimes chest pain. These are just some of the symptoms. (5)

VS: Hypotension, hypoxia, & tachycardia sometimes seen.

TREATMENT: High flow oxygen, hyperbaric oxygen tx, supportive care-monitoring labs. Note that IV insulin may also be important if there is hyperglycemia. This is because “neurological outcomes, following CO poisoning, are worse in patients with hyperglycemia”(2)(4).

AFTER-CARE: It is extremely important to determine the source of the carbon monoxide poisoning, as doing so can help prevent further occurences. An in-home carbon monoxide detector is highly recommended

(This does not substitute for medical advice and this is not an all-inclusive list-as there are other abnormalities sometimes seen)

CARBON MONOXIDE DETECTORS SAVE LIVES!!!

REFERENCE:

  1. CDC Carbon Monoxide Poisoning
  2. Epocrates:
    . I highly recommend signing up for Epocrates. There is a free (drugs) and a paid version- runs anywhere from 150-180 per year-but so worth it! I have been using it for years and years and couldn’t go without it! I use it more than any other medical app.
  3. NCBI Carbon monoxide poisoning (acute)
  4. White SR, Penney DG. Initial study: effects of insulin and glucose treatment on neurological outcome after CO poisoning. Ann Emrg Med. 1994;23:606-607
  5. emedicinehealth.com
DISCLAIMER: The information posted is not intended to be medical advice. This is simply for educational purposesonly. This information is intended for medical professionals & students only. All patients should ALWAYS check with their primary care provider with any questions regarding their health. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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