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Diagnosis of Carbon Monoxide Poisoning

John H. Eckfeldt, MD, PhD
JAMA. 1978;240(11):1140-1141. doi:10.1001/jama.1978.03290110038012.
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To the Editor.—  In a recent article (239:1515, 1978) Kelley and Sophocleus point out the difficulty in making the clinical diagnosis of carbon monoxide poisoning. They emphasize that ophthalmoscopy should always be performed in patients with nausea, headache, and dizziness, and that retinal hemorrhages should suggest the possibility of CO poisoning. Following their recommendations will certainly add to the clinical examination of such patients, but I believe several statements in their article are confusing regarding the laboratory diagnosis of CO poisoning.In several places the authors refer to serum CO measurements. Clearly, anticoagulated whole blood, rather than a clotted serum tube, is the proper specimen to submit to the laboratory, since virtually all the CO in the blood is tightly bound to the RBC's hemoglobin.Furthermore, the authors report that "blood gas analysis showed a carbon monoxide saturation value of 27%." The implication of this statement, though perhaps not intentional,


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