KARBONMONOKSIDA
Yahya Taqiuddin R. (011611133046)
Rania Tasya I. (011611133082)
Adra Achirultan R. S. (011611133083)
Eka Candra S. (011611133140)
Rizky Istifarina (011611133203)
Karakteristik Gas CO
• Tidak berwarna, tidak berbau
• Tidak berbau
• Tak berasa
• Tidak merangsang
• Sifat karbon monoksida dapat mengikat 200 kali lebih cepat dari oksigen ( Ahmad,
2004).
• Mengganggu aktifitas seluler lainnya yaitu dengan mengganggu fungsi organ
yang menggunakan sejumlah besar oksigen seperti otak dan jantung. Efek paling
serius adalah terjadi keracunan secara langsung terhadap sel-sel otot jantung,
juga menyebabkan gangguan pada sistem saraf (Santoso, 1999)
Patofisiologi
• Keracunan karbonmonoksida dapat menyebabkan turunnya kapasitas
transportasi oksigen dalam darah oleh hemoglobin dan penggunaan oksigen
ditingkat seluler.
• Karbonmonoksida mempengaruhi berbagai organ di dalam tubuh,organ yang
paling terganggu adalah yang mengkonsumsi oksigen dalam jumlah besar,
seperti otak dan jantung
Patofisiologi
• Efek toksisitas utama adalah hasil dari hipoksia seluler yang disebabkan oleh
gangguan transportasi oksigen. CO mengikat hemoglobin secara reversible,
yang menyebabkan anemia relatif karena CO mengikat hemoglobin 230-270
kali lebih kuat daripada oksigen. Kadar HbCO 16% sudah dapat
menimbulkan gejala klinis. CO yang terikat hemoglobin menyebabkan
ketersediaan oksigen untuk jaringan menurun.
• CO mengikat cytochromes c dan P450 yang mempunyai daya ikat lebih
lemah dari oksigen yang diduga menyebabkan defisit neuropsikiatris.
• Beberapa penelitian mengindikasikan bila CO dapat menyebabkan
peroksidasi lipid otak dan perubahan inflamasi di otak yang dimediasi oleh
lekosit. Proses tersebut dapat dihambat dengan terapi hiperbarik oksigen
Kao, L. and Nañagas, K. (2019). Carbon monoxide poisoning.. [online]
Semanticscholar.org. Available at: https://www.semanticscholar.org/paper/Carbon-
monoxide-poisoning.-Kao-Na%C3%B1agas/
901f708131ae5a02b9e266a7f93b654d16d02a8d [Accessed 17 Dec. 2019].
Rekomendasi dari College of Emergency Medicine di antara sumber pendapat ahli lainnya adalah bahwa TOHB
mungkin berguna jika seseorang menderita salah satu dari berikut:
Kehamilan
Kehilangan kesadaran
Rekomendasi saat ini adalah bahwa tiga sesi TOHB dilakukan dalam 24 jam pertama setelah terjadi keracunan CO.
Weaver, L., Hopkins, R., Chan, K., Churchill, S., Elliott, C., Clemmer, T., Orme, J., Thomas, F. and Morris,
A. (2002). Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning. New England Journal of Medicine,
347(14), pp.1057-1067.
Kasus 1
• This 15-year-old boy was found at home with reduced consciousness at about 6:30 am on 25
June 2008 According to his parents' statement, he had slept in his room, which is next to the
room containing the home water heater. His father had taken a bath at 11:00 p.m. He was first
sent to a local hospital, where he was found to be comatose with urine incontinence and
cyanosis.
• Arterial blood gases showed pH 7.3, PaCO 2 31.8, PaO2 40.9 mmHg, HCO3 16, SaO2 72%, and SBE
-8.5. Hypoxemia was found. His spontaneous breathing was shallow and weak with O2 mask
with oxygen 6 L/min. He was intubated and supplied 100% O 2. Hypotension was detected after
intubation.
• Dopamine 20 μg/kg/min was given. Brain computed tomography revealed brain edema, and the
chest x-ray showed bilateral pulmonary edema. The arterial carboxyhemoglobin (COHb) level
within 1 hour after discovery was 51.9%. Pertinent laboratory values included ammonia 103
μg/dL, Na 141 mEq/L, K 3.8 mEq/L, Ca 9.9 mg/dL, glucose 198 mg/dL, WBC 17,490, Hb 16.3 g/dL,
and platelets 336,000. Fresh blood and pink foamy sputum were noted from the endotracheal
tube. Given his critical condition, he was transferred to our hospital for further management.
• One hour after admission, hypotension necessitated the initiation of a dopamine infusion. The
infusion was titrated to effect, with 10 μg/kg/min of dopamine.
Wu, C., Huang, J. and Hsia, S. (2009). Acute carbon monoxide poisoning with severe cardiopulmonary compromise: a case report. Cases Journal, [online] 2(1). Available at:
https://casesjournal.biomedcentral.com/articles/10.1186/1757-1626-2-52#Fig1 [Accessed 6 Dec. 2019].
• Echocardiography showed an ejection fraction of dopamine was discontinued. He was extubated
55%. Four hours after admission, the arterial COHb successfully on day five. The neurological findings
was 8.4% and the serum cardiac troponin I was 4.19 were normal after extubation. He was transferred
ng/mL (normal < 0.4 ng/mL). Acute pulmonary from the pediatric intensive care unit to the
edema was diagnosed by chest x-ray. The pediatric ward on day 6, and no longer required
pulmonary edema was treated with 100% oxygen, oxygen.
with increased positive end-expiratory pressure up
to 12 cm H2O. The follow-up chest x-ray showed
worsening pulmonary edema with increasing
bilateral alveolar consolidation. Arterial blood gases
showed severe hypoxemia. Acute respiratory
distress syndrome was suspected. High-frequency
oscillator ventilation was set to maintain a PaO2
greater than 50 mm Hg and an oxygen saturation
greater than 85%. Beginning 10–12 hours after
admission, the pulmonary condition improved
progressively. The blood pressure also became
more stable (> 90/50 mmHg).
• Over the next few days, the patient's cardiovascular
and respiratory status kept improving. The serum
cardiac troponin I level declined. The neurological
findings remained a concern. On day four, the Chest x-ray : bilateral acute pulmonary edema
Wu, C., Huang, J. and Hsia, S. (2009). Acute carbon monoxide poisoning with severe cardiopulmonary compromise: a case report. Cases Journal, [online] 2(1). Available at:
https://casesjournal.biomedcentral.com/articles/10.1186/1757-1626-2-52#Fig1 [Accessed 6 Dec. 2019].
Kasus 2
• A male patient, Mr S., presented to the ED having been driven there by his wife
after she found him ‘‘barely breathing in the garage with his car running.’’ She
stated she was at work and came home to find him in his car ‘‘very groggy.’’ She
reported, ‘‘he has been depressed for several weeks after losing his job and
consequently having financial hardships.’’
• Mr S. was in a state of respiratory arrest and was intubated shortly after being
admitted to the ED and placed on 100% oxygen. His pupils were dilated and very
sluggish. As he was being intubated, he had a grand mal seizure. His medical
history is significant for diabetes mellitus and according to his wife ‘‘has been fairly
well controlled until this past year.’’ He also had coronary artery bypass surgery 2
years ago and is on blood pressure and cholesterol medications. He is allergic to
sulfa medications.
https://www.researchgate.net/profile/Kristen_Zulkosky/publication/51703090_Carbon_Monoxide_Poisoning_Case_Studies_and_Review/links/5b329b6a4585150d23d584f6/Carbon-
Monoxide-Poisoning-Case-Studies-and-Review.pdf?origin=publication_detail
• Physical examination in the ED revealed a pale man of 74 in who is unkempt and
slightly overweight. He was very lethargic and disoriented. His blood pressure was
166/102 mm Hg, pulse is 102 beats per minute, temperature is 96.4-F, and oxygen
saturation is 92% on room air. His wife stated he is not a smoker. Breath sounds
were diminished, and his respiratory rate was 6 breaths per minute before being
intubated.
• The ED physician obtained a venous blood sample, which revealed the patient’s
COHb level to be 49%, blood sugar of 185 mg/dL, and total cholesterol level of 260
mg/dL; cardiac enzymes and troponin T were within reference range.
• His electrocardiogram showed sinus tachycardia with no ST-T wave changes. An
arterial blood gas was ordered,and plans were under way to transport Mr S. to a
facility where hyperbaric oxygenation (HBO2) could be provided.
https://www.researchgate.net/profile/Kristen_Zulkosky/publication/51703090_Carbon_Monoxide_Poisoning_Case_Studies_and_Review/links/5b329b6a4585150d23d584f6/Carbon-
Monoxide-Poisoning-Case-Studies-and-Review.pdf?origin=publication_detail
Kasus 3
• Seorang mekanik berusia 35 tahun ditemukan hyperemia parah dan pengeluaran cairan
tidak sadarkan diri di garasi mobil selama jam berbusa.
kerja di pusat Delhi pada 2013 dan ia meninggal •
satu jam setelah dirawat di rumah sakit pada Hipostasis, sub-scapel tissue, otot-otot dada,
hari yang sama. dan dinding perut berwarna merah ceri yang
menunjukkan keracunan monoksida.
• Pada pemeriksaan luar, Rigor mortis telah •
terjadi di seluruh tubuh, lividitas postmortem Paru-paru basah, bersinar dengan beberapa
merah ceri terjadi pada punggung dan bagian- tambalan antrasit diskrit dan edematous
bagian tubuh yang tergantung pada posisi sedang hingga berat.
terlentang (Gambar 1) • Perdarahan petekiae sebagai tanda asfiksia
• Ada sianosis dari tubuh dengan perdarahan sub juga terlihat pada jaringan epicardial dan otak.
konjungtiva. Di wajah terlihat beberapa • Analasisis kimia darah dan visera
perdarahan petekiae diskrit. Ada edema mengonfirmasi toksisitas dengan karbon
laringotorakeal yang ditandai dengan monoksida
• Gambar 1
• Sumber: Chand-Meena M. Accidental Death due to Carbon Monoxide: Case
Report. International Journal of Medical Toxicology and Forensic Medicine.
2014;4(4):158-61.
Kerangka Konsep
Keracunan Gas CO
Identitas
Tensi, Nadi, RR, Arterial Blood Gas Analysis
Tanda dan gejala
Suhu Thorax X-photo, CT Scan dan
Riwayat penyakit
MRI, EKG, Pulse oximetry,
CO-oxymetry
Penegakan Diagnosis
Terapi
sembuh
Daftar Pustaka
• Ik.pom.go.id. (2019). [online] Available at: http://ik.pom.go.id/v2016/artikel/KARACUNAN_KARBON_MONOKSIDA.pdf [Accessed 3 Dec.
2019].
• Journal.unair.ac.id. (2019). [online] Available at: http://journal.unair.ac.id/download-fullpapers-CO%20Intoxication.pdf [Accessed 3 Dec.
2019].
• Ddrc.org. (2019). Carbon Monoxide Poisoning and Hyperbaric Oxygen | DDRC Healthcare. [online] Available at:
https://www.ddrc.org/carbon-monoxide-poisoning/ [Accessed 3 Dec. 2019].
• MSD Manual Consumer Version. (2019). Gas Toxicity During Diving - Injuries and Poisoning - MSD Manual Consumer Version. [online]
Available at: https://www.msdmanuals.com/home/injuries-and-poisoning/diving-and-compressed-air-injuries/gas-toxicity-during-
diving#v827801 [Accessed 3 Dec. 2019].
• Chand-Meena M. Accidental Death due to Carbon Monoxide: Case Report. International Journal of Medical Toxicology and Forensic
Medicine. 2014;4(4):158-61. Ruth-Sahd, L., Zulkosky, K. and Fetter, M. (2011). Carbon Monoxide Poisoning. Dimensions of Critical Care
Nursing, 30(6), pp.303-314.
• Wu, C., Huang, J. and Hsia, S. (2009). Acute carbon monoxide poisoning with severe cardiopulmonary compromise: a case
report. Cases Journal, [online] 2(1). Available at: https://casesjournal.biomedcentral.com/articles/10.1186/1757-1626-2-
52#Fig1 [Accessed 6 Dec. 2019].
• Available at: https://www.researchgate.net/profile/Kristen_Zulkosky/publication/
51703090_Carbon_Monoxide_Poisoning_Case_Studies_and_Review/links/5b329b6a4585150d23d584f6/Carbon-Monoxide-Poisoning-
Case-Studies-and-Review.pdf?origin=publication_detail [Accessed 6 Dec. 2019].
• Ahmad, Rukaesih. 2004. Kimia Lingkungan. Yogyakarta: Andi Yogyakarta
• Santoso Budi, 1999, Ilmu Lingkungan Industri, Universitas Gunadarna, Depok