Dear Graham,
I am not sure which CO breath meter your colleagues
are using, but commonly the elctrochemical detectors in these devices can
cross react with hydrogen in breath. I was involved in a case a few years
ago, where a member of staff in a smoking clinic had a high CO reading. In
the end it was found he had lactose intolerance in which he was exhaling
large amounts of hyrdrogen which gave a high reading on the CO meter. I
would suggest you also check this chaps breath hydrogen.
Regards
Simon Fleming
Royal Cornwall Hospital
Truro.
-----Original Message-----
From: Graham Jones [mailto:[log in to unmask]]
Sent: Monday, February 18, 2002 05:24
To: [log in to unmask]
Subject: Carboxyhaemoglobin elevations
Dear Colleagues,
Another query from down under!
I have had an enquiry about elevated carboxyhaemoglobin levels in a patient
with venous thromboembolic disease. The patient is a smoker (light) with
recent pulmonary embolus. Using a breath measuring device for carbon
monoxide the physician found an elevated level which apparently translates
to about 30% COHb. A formal measurement by co-oximetry gave about 10% after
over 24 hours off the ciggies.
My list of causes of elevated carboxyHb (due to High CO) include cigarette
smoking, smoke inhalation and haemolysis. Regarding haemolysis the
literature concentrates on this effect in neonates but I am interested an
anyone's experience in adults (we have seen a level of 4.8% in a pyruvate
kinase deficient patient). Regarding smoke exposure, as it is Australia in
the summer, it seems unlikely that heating systems could be implicated.
Any additions to this list of causes of elevated CO and/or carboxyHb,
particularly with regard to thromboebolic disease, would be most welcome.
Many thanks,
Graham
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
Victoria St, Darlinghurst, 2010
NSW, Australia
Ph: (02) 8382-2170 Fax (02) 8382-2489
[log in to unmask]
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