Sohail Sabir, Tassawar Hussain, Mowadat Hussain Rana, Asma Asghar.
Renal and Neuropsychiatric manifestations of carbon monoxide poisoning.
Pak Armed Forces Med J Jan ;55(3):247-50.

The patient under discussion is a 62 year old non-smoker male with no background history of diabetes mellitus, ischemic heart disease, hypertension or any other medical or surgical ailment. The victim was found unconscious one morning in the closed room where he had slept the whole night with the gas heater on. According to the relatives he was alright before sleeping that night. He was taken immediately to a peripheral hospital where emergency management was done, suspecting CO poisoning. He regained consciousness within hours with the administration of oxygen. His initial baseline investigations which included blood complete picture, urine routine examination, cardiac enzymes, and hepatic and renal profiles were essentially normal. Next day his condition started deteriorating with progressively reducing conscious level and generalized weakness. His urine output started declining and he became anuric. Investigations were repeated and they revealed Hb 11.2g/dL , TLC 12.6 x109/L, serum urea was 29.5 mmol/L, creatinine 677.4 pmol/L ALT 99U/ L. Urine RE was normal. Patient was hemodialysed urgently which led to transient improvement and was transferred to Military Hospital (MH) Rawalpindi for further management and nephrology consultation on fourth day of admission. The patient was reassessed in MH Rawalpindi where on examination he was found to be disoriented and hypertalkative, vital signs were normal and systemic examination revealed ataxic gait.

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