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Question 8 of 189

A 21-year-old student is brought to the Emergency Department by his friends due to him being confused. They
report he has been complaining of headaches for the past few weeks. He has a low-grade pyrexia and on
examination is noted to have abnormally pink mucosa. What is the most likely diagnosis?

Carbon monoxide poisoning

Meningitis

Paracetamol overdose

Subarachnoid haemorrhage

Methaemoglobinaemia

Confusion and pink mucosae are typical features of carbon monoxide poisoning. A low-grade pyrexia is seen in a
minority of cases.

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Carbon monoxide poisoning

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Carbon monoxide has high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation
curve and tissue hypoxia. There are approximately 50 per year deaths from accidental carbon monoxide poisoning
in the UK

Questions may hint at badly maintained housing e.g. student houses

Features of carbon monoxide toxicity


headache: 90% of cases
nausea and vomiting: 50%
vertigo: 50%
confusion: 30%
subjective weakness: 20%
severe toxicity: 'pink' skin and mucosae, hyperpyrexia, arrhythmias, extrapyramidal features, coma, death

Typical carboxyhaemoglobin levels


< 3% non-smokers
< 10% smokers
10 - 30% symptomatic: headache, vomiting
> 30% severe toxicity

Management
100% oxygen
hyperbaric oxygen

Indications for hyperbaric oxygen*


loss of consciousness at any point
neurological signs other than headache
myocardial ischaemia or arrhythmia
pregnancy

*as stated in the 2008 Department of Health publication 'Recognising Carbon Monoxide Poisoning'

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