array:19 [
  "pii" => "13055466"
  "issn" => "15792129"
  "estado" => "S300"
  "fechaPublicacion" => "2003-12-01"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Arch Bronconeumol. 2003;39:601-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 5345
    "formatos" => array:3 [
      "EPUB" => 157
      "HTML" => 4378
      "PDF" => 810
    ]
  ]
  "itemSiguiente" => array:15 [
    "pii" => "13055467"
    "issn" => "15792129"
    "estado" => "S300"
    "fechaPublicacion" => "2003-12-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2003;39:603"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2660
      "formatos" => array:3 [
        "EPUB" => 144
        "HTML" => 1739
        "PDF" => 777
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Gerardo Manresa, Farewell"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "603"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Gerardo Manresa: adiós"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R Anglès Besa"
          "autores" => array:1 [
            0 => array:2 [
              "Iniciales" => "R"
              "apellidos" => "Anglès Besa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055467?idApp=UINPBA00003Z"
    "url" => "/15792129/0000003900000012/v0_201307090853/13055467/v0_201307090854/en/main.assets"
  ]
  "itemAnterior" => array:15 [
    "pii" => "13055465"
    "issn" => "15792129"
    "estado" => "S300"
    "fechaPublicacion" => "2003-12-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2003;39:601"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6424
      "formatos" => array:3 [
        "EPUB" => 187
        "HTML" => 5403
        "PDF" => 834
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Solitary Metastasis to the Pancreas in a Patient With Lung Cancer"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "601"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Metástasis pancreática solitaria en paciente con neoplasia de pulmón"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C García Vidal, E Carrillo, B Barreiro"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "C"
              "apellidos" => "García Vidal"
            ]
            1 => array:2 [
              "Iniciales" => "E"
              "apellidos" => "Carrillo"
            ]
            2 => array:2 [
              "Iniciales" => "B"
              "apellidos" => "Barreiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055465?idApp=UINPBA00003Z"
    "url" => "/15792129/0000003900000012/v0_201307090853/13055465/v0_201307090854/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "titulo" => "Pulmonary Infiltrates Secondary to Carbon Monoxide Intoxication"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "601"
        "paginaFinal" => "602"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "E Antón, RM Girón Moreno, E Zamora"
        "autores" => array:3 [
          0 => array:3 [
            "Iniciales" => "E"
            "apellidos" => "Antón"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "RM"
            "apellidos" => "Gir&#243;n Moreno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "E"
            "apellidos" => "Zamora"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Neumología, Hospital Universitario La Princesa, Madrid, Spain."
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Infiltrados pulmonares secundarios a intoxicaci&#243;n por mon&#243;xido de carbono"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span> Carbon monoxide &#40;CO&#41; intoxication is a common occurrence in industrialized cities&#46; Most intoxications are accidental&#46; CO is a product of the imperfect combustion of hydrocarbons&#44; and the amount of gas absorbed depends on minute ventilation&#44; time of exposure&#44; and relative concentrations of CO and oxygen in the atmosphere&#46; We report the case of a woman who developed pulmonary infiltrates secondary to carbon monoxide intoxication&#46;</p><p class="elsevierStylePara">A 25-year-old woman with no relevant medical history&#44; drug allergy&#44; or toxic habits&#44; and treated with oral contraceptives&#44; came to the emergency service of our hospital complaining of dyspnea&#44; malaise&#44; somnolence&#44; dizziness&#44; and reporting an episode of loss of consciousness without relaxation of sphincters or convulsions&#46; Symptoms had begun the night before admission&#46;</p><p class="elsevierStylePara">On physical examination&#44; the patient was afebrile&#44; blood pressure was 110&#47;55 mm Hg&#44; and heart rate was 125 beats&#47;min&#46; On auscultation of the lungs&#44; vesicular sounds were diminished on both sides&#46; A chest x-ray showed an increase in alveolar and interstitial density in the right and left upper lobes and left lower lobe &#40;Figure 1a&#41;&#46; Blood tests showed a white cell count of 25 000 cells&#47;mL with 85&#37; concentration of polymorphonuclear cells&#59; other parameters were well within the normal ranges&#46; The baseline arterial blood gas analysis showed pH to be 7&#46;22&#44; PaO<span class="elsevierStyleInf">2</span> 44 mm Hg&#44; PaCO<span class="elsevierStyleInf">2</span> 29&#46;7 mm Hg&#44; and bicarbonate concentration 12&#46;5 mmol&#47;L&#46; Carboxyhemoglobin was 23&#46;6&#37; and lactic acid was 2&#46;16 mmol&#47;L&#46;</p><p class="elsevierStylePara"><img src="260v39n12-13055466tab01.gif"></img></p><p class="elsevierStylePara">Figure 1&#46; Posteroanterior chest x-rays showing&#58; a&#41; the pulmonary infiltrates toward the onset of symptoms and b&#41; the resolution of the infiltrates within a few hours&#46;</p><p class="elsevierStylePara">The patient was diagnosed with CO intoxication and suspected aspiration pneumonia&#44; and highly concentrated oxygen therapy was prescribed along with sodium bicarbonate&#44; corticosteroids&#44; antibiotics&#44; and bronchodilators&#46; The only source of CO the patient had been exposed to was a home boiler&#46; The clinical response was satisfactory&#46; The chest x-ray at 24 hours of admission was normal and pulmonary infiltrates disappeared &#40;Figure 1b&#41;&#46; Two days after admission&#44; respiratory function tests were carried out&#58; vital capacity was 3&#46;88 L &#40;96&#37;&#41;&#44; forced vital capacity &#40;FVC&#41; was 3&#46;62 L &#40;91&#37;&#41;&#44; forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; was 3&#46;26 L&#47;s &#40;93&#37;&#41;&#44; and the ratio FEV<span class="elsevierStyleInf">1</span>&#47;FVC was 90&#37;&#46; The CO diffusion capacity was 8&#46;23 mmol&#47;min&#47;KPa &#40;82&#46;3&#37;&#41; and the diffusion per unit of lung volume &#40;KCO&#41; was 1&#46;66 mmol&#47;min&#47;KPa&#47;L &#40;77&#46;3&#37;&#41;&#46; KCO change was monitored for 1 year and was observed to increase&#46;</p><p class="elsevierStylePara">CO is an odorless&#44; colorless&#44; nonirritating gas that is easily absorbed by the lungs and whose toxicity is due to the combination of tissue hypoxia and direct cell damage&#46;<span class="elsevierStyleSup">1</span> CO competes with oxygen to combine with hemoglobin&#44; for which it has a 200- to 500-fold higher affinity&#46;<span class="elsevierStyleSup">2</span> The consequence of carboxyhemoglobin combination is a reduction in the amount of oxygen bound to hemoglobin and a shift in the oxygen-hemoglobin dissociation curve to the left&#44; so that the availability of oxygen in tissues decreases&#46; The tissues that are most sensitive to the toxic effect of this gas are those with greater metabolic need&#44; such as the central nervous system and the myocardium&#46; The most frequent symptoms are headache&#44; dizziness&#44; asthenia&#44; nausea&#44; vomiting&#44; and difficulty concentrating&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">A high level of suspicion is necessary to reach a diagnosis of CO intoxication&#46; A firm diagnosis is established by measuring blood carboxyhemoglobin values&#44;<span class="elsevierStyleSup">4</span> which are high in these patients&#44; normal values being 5&#37; to 9&#37; in adult smokers and 2&#37; in adult nonsmokers&#46; Decreased oxygen saturation&#44; altered PaCO<span class="elsevierStyleInf">2</span> and PaO<span class="elsevierStyleInf">2</span>&#44; and metabolic acidosis caused by an anaerobic metabolism in hypoxic tissues are evident in arterial blood gas measurements&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Pulmonary infiltrates have been described in patients who have been in burning buildings and have inhaled CO and other gases resulting from the combustion of plastics and other synthetic materials that irritate the respiratory mucosa&#46; In CO intoxication&#44; pulmonary involvement has been described only rarely&#46; In a series of 2759 patients&#44; 35 had pneumonia and 10 had pulmonary edema&#44; though the latter was observed in more than a half of the most serious cases&#46; Two pathogenic mechanisms related to hypoxia have been suggested&#58; altered permeability of lung capillaries and myocardial infarction&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">In the case we present&#44; the patient had only been exposed to CO&#46; The presence of pulmonary infiltrates was first attributed to aspiration pneumonia occurring when she was unconscious&#44; and antibiotics were therefore prescribed&#46; However&#44; as the patient never developed fever and the infiltrates disappeared in a few hours&#44; that diagnosis was unlikely&#46; The parenchymal changes were attributed to the possible presence of noncardiogenic pulmonary edema caused by CO&#44; although we cannot rule out the possibility of chemical pneumonitis secondary to the aspiration of gastric content&#46;</p><p class="elsevierStylePara">Oxygen &#40;100&#37;&#41; is administered to treat CO intoxication in order to shorten the half-life of carboxyhemoglobin and increase oxygen uptake by tissues&#46; Comatose patients may require intubation and mechanical ventilation&#44; and hyperbaric oxygen may be useful&#44; though it is controversial&#46; However&#44; some authors believe that hyperbaric oxygen reduces late functional abnormalities related to the use of normobaric oxygen&#44; even in noncomatose patients&#46;</p>"
    "pdfFichero" => "260v39n12a13055466pdf001.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl1"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "260v39n12-13055466tab01.gif"
                  "imagenAlto" => 547
                  "imagenAncho" => 255
                  "imagenTamanyo" => 46727
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Posteroanterior chest x-rays showing&#58; a&#41; the pulmonary infiltrates toward the onset of symptoms and b&#41; the resolution of the infiltrates within a few hours&#46;"
        ]
      ]
      1 => array:5 [
        "identificador" => "tbl2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Ernst A"
                            1 => "Zibrat J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199811263392206"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1998"
                        "volumen" => "339"
                        "paginaInicial" => "1603"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9828249"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Walker E"
                            1 => "Hay A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1999"
                        "volumen" => "319"
                        "paginaInicial" => "1082"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10531079"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Intoxicaci&#243;n por mon&#243;xido de carbono&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Rubio Barb&#243;n S"
                            1 => "Garc&#237;a Fern&#225;ndez ML&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin (Barc)"
                        "fecha" => "1997"
                        "volumen" => "108"
                        "paginaInicial" => "776"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Niveles de carboxihemoglobina en relaci&#243;n con la calefacci&#243;n dom&#233;stica&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gonz&#225;lez JM"
                            1 => "Barrueco M"
                            2 => "Cordovilla R"
                            3 => "G&#243;mez F"
                            4 => "Hern&#225;ndez MA"
                            5 => "Rodr&#237;guez MC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1997"
                        "volumen" => "33"
                        "paginaInicial" => "378"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9376937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Fisher J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1999"
                        "volumen" => "115"
                        "paginaInicial" => "322"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10027426"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#58; systemic manifestations and complications&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Choi IS&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3346/jkms.2001.16.3.253"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Med Sci"
                        "fecha" => "2001"
                        "volumen" => "16"
                        "paginaInicial" => "253"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11410684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000003900000012/v0_201307090853/13055466/v0_201307090854/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14576"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Letters to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000003900000012/v0_201307090853/13055466/v0_201307090854/en/260v39n12a13055466pdf001.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055466?idApp=UINPBA00003Z"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Pulmonary Infiltrates Secondary to Carbon Monoxide Intoxication
Infiltrados pulmonares secundarios a intoxicación por monóxido de carbono
E. Antóna, RM. Girón Morenoa, E. Zamoraa
a Servicio de Neumología, Hospital Universitario La Princesa, Madrid, Spain.
Read
12357
Times
was read the article
2489
Total PDF
9868
Total HTML
Share statistics
 array:19 [
  "pii" => "13055466"
  "issn" => "15792129"
  "estado" => "S300"
  "fechaPublicacion" => "2003-12-01"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Arch Bronconeumol. 2003;39:601-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 5345
    "formatos" => array:3 [
      "EPUB" => 157
      "HTML" => 4378
      "PDF" => 810
    ]
  ]
  "itemSiguiente" => array:15 [
    "pii" => "13055467"
    "issn" => "15792129"
    "estado" => "S300"
    "fechaPublicacion" => "2003-12-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2003;39:603"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2660
      "formatos" => array:3 [
        "EPUB" => 144
        "HTML" => 1739
        "PDF" => 777
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Gerardo Manresa&#44; Farewell"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "603"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Gerardo Manresa&#58; adi&#243;s"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R Angl&#232;s Besa"
          "autores" => array:1 [
            0 => array:2 [
              "Iniciales" => "R"
              "apellidos" => "Angl&#232;s Besa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055467?idApp=UINPBA00003Z"
    "url" => "/15792129/0000003900000012/v0_201307090853/13055467/v0_201307090854/en/main.assets"
  ]
  "itemAnterior" => array:15 [
    "pii" => "13055465"
    "issn" => "15792129"
    "estado" => "S300"
    "fechaPublicacion" => "2003-12-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2003;39:601"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6424
      "formatos" => array:3 [
        "EPUB" => 187
        "HTML" => 5403
        "PDF" => 834
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Solitary Metastasis to the Pancreas in a Patient With Lung Cancer"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "601"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Met&#225;stasis pancre&#225;tica solitaria en paciente con neoplasia de pulm&#243;n"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C Garc&#237;a Vidal, E Carrillo, B Barreiro"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "C"
              "apellidos" => "Garc&#237;a Vidal"
            ]
            1 => array:2 [
              "Iniciales" => "E"
              "apellidos" => "Carrillo"
            ]
            2 => array:2 [
              "Iniciales" => "B"
              "apellidos" => "Barreiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055465?idApp=UINPBA00003Z"
    "url" => "/15792129/0000003900000012/v0_201307090853/13055465/v0_201307090854/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "titulo" => "Pulmonary Infiltrates Secondary to Carbon Monoxide Intoxication"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "601"
        "paginaFinal" => "602"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "E Ant&#243;n, RM Gir&#243;n Moreno, E Zamora"
        "autores" => array:3 [
          0 => array:3 [
            "Iniciales" => "E"
            "apellidos" => "Ant&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "RM"
            "apellidos" => "Gir&#243;n Moreno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "E"
            "apellidos" => "Zamora"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Neumología, Hospital Universitario La Princesa, Madrid, Spain."
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Infiltrados pulmonares secundarios a intoxicaci&#243;n por mon&#243;xido de carbono"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span> Carbon monoxide &#40;CO&#41; intoxication is a common occurrence in industrialized cities&#46; Most intoxications are accidental&#46; CO is a product of the imperfect combustion of hydrocarbons&#44; and the amount of gas absorbed depends on minute ventilation&#44; time of exposure&#44; and relative concentrations of CO and oxygen in the atmosphere&#46; We report the case of a woman who developed pulmonary infiltrates secondary to carbon monoxide intoxication&#46;</p><p class="elsevierStylePara">A 25-year-old woman with no relevant medical history&#44; drug allergy&#44; or toxic habits&#44; and treated with oral contraceptives&#44; came to the emergency service of our hospital complaining of dyspnea&#44; malaise&#44; somnolence&#44; dizziness&#44; and reporting an episode of loss of consciousness without relaxation of sphincters or convulsions&#46; Symptoms had begun the night before admission&#46;</p><p class="elsevierStylePara">On physical examination&#44; the patient was afebrile&#44; blood pressure was 110&#47;55 mm Hg&#44; and heart rate was 125 beats&#47;min&#46; On auscultation of the lungs&#44; vesicular sounds were diminished on both sides&#46; A chest x-ray showed an increase in alveolar and interstitial density in the right and left upper lobes and left lower lobe &#40;Figure 1a&#41;&#46; Blood tests showed a white cell count of 25 000 cells&#47;mL with 85&#37; concentration of polymorphonuclear cells&#59; other parameters were well within the normal ranges&#46; The baseline arterial blood gas analysis showed pH to be 7&#46;22&#44; PaO<span class="elsevierStyleInf">2</span> 44 mm Hg&#44; PaCO<span class="elsevierStyleInf">2</span> 29&#46;7 mm Hg&#44; and bicarbonate concentration 12&#46;5 mmol&#47;L&#46; Carboxyhemoglobin was 23&#46;6&#37; and lactic acid was 2&#46;16 mmol&#47;L&#46;</p><p class="elsevierStylePara"><img src="260v39n12-13055466tab01.gif"></img></p><p class="elsevierStylePara">Figure 1&#46; Posteroanterior chest x-rays showing&#58; a&#41; the pulmonary infiltrates toward the onset of symptoms and b&#41; the resolution of the infiltrates within a few hours&#46;</p><p class="elsevierStylePara">The patient was diagnosed with CO intoxication and suspected aspiration pneumonia&#44; and highly concentrated oxygen therapy was prescribed along with sodium bicarbonate&#44; corticosteroids&#44; antibiotics&#44; and bronchodilators&#46; The only source of CO the patient had been exposed to was a home boiler&#46; The clinical response was satisfactory&#46; The chest x-ray at 24 hours of admission was normal and pulmonary infiltrates disappeared &#40;Figure 1b&#41;&#46; Two days after admission&#44; respiratory function tests were carried out&#58; vital capacity was 3&#46;88 L &#40;96&#37;&#41;&#44; forced vital capacity &#40;FVC&#41; was 3&#46;62 L &#40;91&#37;&#41;&#44; forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; was 3&#46;26 L&#47;s &#40;93&#37;&#41;&#44; and the ratio FEV<span class="elsevierStyleInf">1</span>&#47;FVC was 90&#37;&#46; The CO diffusion capacity was 8&#46;23 mmol&#47;min&#47;KPa &#40;82&#46;3&#37;&#41; and the diffusion per unit of lung volume &#40;KCO&#41; was 1&#46;66 mmol&#47;min&#47;KPa&#47;L &#40;77&#46;3&#37;&#41;&#46; KCO change was monitored for 1 year and was observed to increase&#46;</p><p class="elsevierStylePara">CO is an odorless&#44; colorless&#44; nonirritating gas that is easily absorbed by the lungs and whose toxicity is due to the combination of tissue hypoxia and direct cell damage&#46;<span class="elsevierStyleSup">1</span> CO competes with oxygen to combine with hemoglobin&#44; for which it has a 200- to 500-fold higher affinity&#46;<span class="elsevierStyleSup">2</span> The consequence of carboxyhemoglobin combination is a reduction in the amount of oxygen bound to hemoglobin and a shift in the oxygen-hemoglobin dissociation curve to the left&#44; so that the availability of oxygen in tissues decreases&#46; The tissues that are most sensitive to the toxic effect of this gas are those with greater metabolic need&#44; such as the central nervous system and the myocardium&#46; The most frequent symptoms are headache&#44; dizziness&#44; asthenia&#44; nausea&#44; vomiting&#44; and difficulty concentrating&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">A high level of suspicion is necessary to reach a diagnosis of CO intoxication&#46; A firm diagnosis is established by measuring blood carboxyhemoglobin values&#44;<span class="elsevierStyleSup">4</span> which are high in these patients&#44; normal values being 5&#37; to 9&#37; in adult smokers and 2&#37; in adult nonsmokers&#46; Decreased oxygen saturation&#44; altered PaCO<span class="elsevierStyleInf">2</span> and PaO<span class="elsevierStyleInf">2</span>&#44; and metabolic acidosis caused by an anaerobic metabolism in hypoxic tissues are evident in arterial blood gas measurements&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Pulmonary infiltrates have been described in patients who have been in burning buildings and have inhaled CO and other gases resulting from the combustion of plastics and other synthetic materials that irritate the respiratory mucosa&#46; In CO intoxication&#44; pulmonary involvement has been described only rarely&#46; In a series of 2759 patients&#44; 35 had pneumonia and 10 had pulmonary edema&#44; though the latter was observed in more than a half of the most serious cases&#46; Two pathogenic mechanisms related to hypoxia have been suggested&#58; altered permeability of lung capillaries and myocardial infarction&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">In the case we present&#44; the patient had only been exposed to CO&#46; The presence of pulmonary infiltrates was first attributed to aspiration pneumonia occurring when she was unconscious&#44; and antibiotics were therefore prescribed&#46; However&#44; as the patient never developed fever and the infiltrates disappeared in a few hours&#44; that diagnosis was unlikely&#46; The parenchymal changes were attributed to the possible presence of noncardiogenic pulmonary edema caused by CO&#44; although we cannot rule out the possibility of chemical pneumonitis secondary to the aspiration of gastric content&#46;</p><p class="elsevierStylePara">Oxygen &#40;100&#37;&#41; is administered to treat CO intoxication in order to shorten the half-life of carboxyhemoglobin and increase oxygen uptake by tissues&#46; Comatose patients may require intubation and mechanical ventilation&#44; and hyperbaric oxygen may be useful&#44; though it is controversial&#46; However&#44; some authors believe that hyperbaric oxygen reduces late functional abnormalities related to the use of normobaric oxygen&#44; even in noncomatose patients&#46;</p>"
    "pdfFichero" => "260v39n12a13055466pdf001.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl1"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "260v39n12-13055466tab01.gif"
                  "imagenAlto" => 547
                  "imagenAncho" => 255
                  "imagenTamanyo" => 46727
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Posteroanterior chest x-rays showing&#58; a&#41; the pulmonary infiltrates toward the onset of symptoms and b&#41; the resolution of the infiltrates within a few hours&#46;"
        ]
      ]
      1 => array:5 [
        "identificador" => "tbl2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Ernst A"
                            1 => "Zibrat J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199811263392206"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1998"
                        "volumen" => "339"
                        "paginaInicial" => "1603"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9828249"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Walker E"
                            1 => "Hay A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1999"
                        "volumen" => "319"
                        "paginaInicial" => "1082"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10531079"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Intoxicaci&#243;n por mon&#243;xido de carbono&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Rubio Barb&#243;n S"
                            1 => "Garc&#237;a Fern&#225;ndez ML&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin (Barc)"
                        "fecha" => "1997"
                        "volumen" => "108"
                        "paginaInicial" => "776"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Niveles de carboxihemoglobina en relaci&#243;n con la calefacci&#243;n dom&#233;stica&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gonz&#225;lez JM"
                            1 => "Barrueco M"
                            2 => "Cordovilla R"
                            3 => "G&#243;mez F"
                            4 => "Hern&#225;ndez MA"
                            5 => "Rodr&#237;guez MC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1997"
                        "volumen" => "33"
                        "paginaInicial" => "378"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9376937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#46;"
                      "idioma" => "fr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Fisher J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1999"
                        "volumen" => "115"
                        "paginaInicial" => "322"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10027426"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Carbon monoxide poisoning&#58; systemic manifestations and complications&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Choi IS&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3346/jkms.2001.16.3.253"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Med Sci"
                        "fecha" => "2001"
                        "volumen" => "16"
                        "paginaInicial" => "253"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11410684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000003900000012/v0_201307090853/13055466/v0_201307090854/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14576"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Letters to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000003900000012/v0_201307090853/13055466/v0_201307090854/en/260v39n12a13055466pdf001.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055466?idApp=UINPBA00003Z"
]
Article information
ISSN: 15792129
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 11 3 14
2024 October 73 19 92
2024 September 88 23 111
2024 August 81 40 121
2024 July 58 24 82
2024 June 62 31 93
2024 May 57 29 86
2024 April 66 32 98
2024 March 76 32 108
2024 February 65 33 98
2023 July 3 0 3
2023 March 20 4 24
2023 February 103 33 136
2023 January 96 40 136
2022 December 85 45 130
2022 November 107 31 138
2022 October 107 31 138
2022 September 124 29 153
2022 August 95 33 128
2022 July 82 48 130
2022 June 143 58 201
2022 May 110 44 154
2022 April 154 39 193
2022 March 181 70 251
2022 February 180 33 213
2022 January 164 57 221
2021 December 136 56 192
2021 November 139 35 174
2021 October 163 55 218
2021 September 92 53 145
2021 August 91 42 133
2021 July 69 36 105
2021 June 136 41 177
2021 May 106 48 154
2021 April 328 120 448
2021 March 201 48 249
2021 February 187 28 215
2021 January 114 25 139
2020 December 137 32 169
2020 November 119 20 139
2020 October 101 25 126
2020 September 122 15 137
2020 August 104 23 127
2020 July 108 29 137
2020 June 89 19 108
2020 May 126 24 150
2020 April 300 23 323
2020 March 101 17 118
2020 February 102 13 115
2020 January 85 22 107
2019 December 109 23 132
2019 November 123 26 149
2019 October 114 11 125
2019 September 80 23 103
2019 August 92 21 113
2019 July 60 9 69
2019 June 95 15 110
2019 May 60 18 78
2019 April 109 52 161
2019 March 115 19 134
2019 February 105 31 136
2019 January 86 19 105
2018 December 86 26 112
2018 November 106 21 127
2018 October 95 29 124
2018 September 69 17 86
2018 May 36 0 36
2018 April 74 9 83
2018 March 65 1 66
2018 February 62 5 67
2018 January 74 7 81
2017 December 72 3 75
2017 November 48 4 52
2017 October 62 6 68
2017 September 61 3 64
2017 August 62 7 69
2017 July 58 5 63
2017 June 74 10 84
2017 May 74 3 77
2017 April 82 5 87
2017 March 63 1 64
2017 February 47 5 52
2017 January 51 4 55
2016 December 57 3 60
2016 November 72 9 81
2016 October 80 10 90
2016 September 120 15 135
2016 August 65 6 71
2016 July 45 6 51
2016 May 0 6 6
2016 April 1 2 3
2016 March 1 0 1
2016 February 2 3 5
2016 January 0 13 13
2015 December 5 11 16
2015 November 3 8 11
2015 October 61 2 63
2015 September 52 9 61
2015 August 41 9 50
2015 July 47 7 54
2015 June 31 8 39
2015 May 44 8 52
2015 April 32 14 46
2015 March 35 9 44
2015 February 28 4 32
2015 January 29 6 35
2014 December 36 3 39
2014 November 23 5 28
2014 October 39 10 49
2014 September 33 12 45
2014 August 54 9 63
2014 July 34 10 44
2014 June 34 4 38
2014 May 33 10 43
2014 April 47 7 54
2014 March 63 11 74
2014 February 41 12 53
2014 January 45 5 50
2013 December 35 5 40
2013 November 25 7 32
2013 October 35 8 43
2013 September 43 8 51
2013 August 46 14 60
2013 July 44 13 57
2013 June 35 6 41
2013 May 28 8 36
2013 April 19 4 23
2013 March 9 2 11
Show all

Follow this link to access the full text of the article

Archivos de Bronconeumología

Are you a health professional able to prescribe or dispense drugs?