What are the long term effects of CO2 posioning?

[lindenbruce]

Hello all,

Sorry I have been largely absent for nearly a month now. I have a question, non diving related but relevant just the same, about Carbon Dioxide poisoning. A quick background. Mom became very ill last month and spent five days in the hospital. She had been sick for several days before the trip to the hospital and had not eaten during those several days either. And she could ill afford to not eat as she is skin and bones now anyway. She is a 77 year old long time smoker with Emphysema and COPD and has been taking high blood pressure meds for some years now. At the hospital she was found to have a fever, a bad infection someplace but they don't know where(blood test showed elevated white cell counts), some congestion in her lungs, blood O2 levels in the low 80's and high blood CO2 levels blood pressure was wacked out (like 150's over 40's) and she had a high heart beat rate. She had diminished mental ability and slurred speech with lack of coordination and awareness. She has been at home now for two weeks and slowly improving. Stroke has been ruled out as well as a heart attack.

Now for the "but". At times during the day she is suffering from confusion. The problem seems more prevalent in the morning. She can not operate a telephone during her confused states. She can't remember to take her meds at all. She is getting her oxygen tube intermingled with her clothing all the time. She is on O2 24/7 and her blood O2 levels for the last week have been in the 91-96 range. She is eating regular and drinking plenty of fluids. Her level of alertness seems to actually be better in the evening oddly.

So, can anyone advise on the long term effects of CO2 poisoning? I really can't find anything on the net about it. I keep running into the effects of CO poisoning when I do a search. I don't think it is the meds she is on, but that can't be ruled out 100%. I am trying to figure out if she may need long term care or if there is a good chance she will be independent again. Before she got sick she was fully independent. I am now having to take care of her finances as she is not able to do this herself. We have a follow-up with her regular doc early next month. Oh, a CT of her brain did not show any issues and she passed a dementia test before she was discharged from the hospital. It's this darn lingering level of confusion that's bugging me. Thanks, B.

 

[TSandM]

lindenbruce, I'm pretty sure that your mom's condition doesn't have anything to do with long-term effects of high CO2.

However, it is very possible that her CO2 levels are still high, because if her underlying lung disease is sufficiently severe, she may ALWAYS have high CO2. In addition, in elderly people with multiple medical problems, any degree of infection or body stress can contribute to increased confusion.

But if she hasn't had a CO2 level done on the level of oxygen she is using at home, it should be done, because people with severe lung disease can be partially dependent on their hypoxemic drive for adequate breathing, and they can retain CO2 rather badly if supplied with too much oxygen.

 

[lindenbruce]

Okay, so is there an at home test for blood CO2 levels? When she was released from the hospital they told me she needed to be on O2 24/7 for thirty days before her need for supplemental oxygen could be evaluated. I was under the impression it was bad to keep someone on O2 for that long of a period, but then maybe that is via a mask and not a nasal cannula. It makes sense she could still have elevated CO2 levels, especially if she is not breathing correctly and given her pre-existing medical conditions. I will call her medical provider tomorrow and see if I can get her CO2 levels checked. B.

 

[BluewaterSail]

There are monitors available that measure the CO2 level in the breath. There are canullas designed that can both deliver O2 to the patient and CO2 sample to the Capnometer (that's what a device that measures CO2 is called). As the doctor if you can borrow or buy such a monitor.

 

[herbdb]

My mother, in her later years, would get very confused when she had a urinary tract infection. This was the only obvious symptom, which is often the case in the elderly. If mom started acting loopy, we hauled her off to the doctor.

 

[TSandM]

Yes, I think the bottom line is that she needs a follow-up appointment with her doctor, and you need to tell him about her confusion problems. Confusion can have so many sources, it's hard to know where to begin . . . infection, as mentioned, hypoxemia or hypercapnia, many medications, and electrolyte imbalances are only part of the list. If your mother had a catheter in during her hospitalization, urinary tract infection is certainly a possibility. New medications need to be scrutinized, and electrolytes should be checked, as I'm certain she got IV fluids while she was ill.

In addition, serious illness can really take a toll of the functional status of elderly people. Folks who have been compensating effectively for declines in strength, coordination or cognitive ability can reveal the underlying issue when illness reduces their ability to cope. Sometimes this gets better over time, and sometimes people never get back to the level of function they had before the incident.

But this does deserve evaluation by her physician. There may be a simple, treatable cause.

 

[TONY CHANEY]

For starters, very sorry to hear that your mother is ill. I wish her the best. People with severe COPD can become CO2 retainers whereas their CO2 is always at a level that would have a profound effect or non CO2 retainers. I have had patients that are walking and talking with CO2 levels greater than 90. But in some people the body does compensate by having elevated HCO3 which buffers the CO2 and helps to maintain the pH of the body to within somewhat normal levels. (You might want to search info pertaining to ABG (arterial blood gases). The best way to measure the levels of the body is by obtaining an ABG. Yes you can get some values by obtaining a venous blood gas but an ABG is better. (I would almost bet that she has has one during her last visit to the ED). UTI's, as stated above, can cause the symtoms you stated but my only problem is that it resolves after she is awake. Medication is always a concern. I would suggest, and this is only a suggestion, 1) does she snore while she is sleeping? I so she might be obstructing during sleep and thus increasing her already elevated CO2. Possible need for CPAP during sleep. 2) Is she a mouth breather during sleep? This can cause her oxygen to decrease during sleep because she is breathing in roor air via her mouth instead of the oxygen that is placed in her nose. Suggestion, go to a drug store and and get a pulse Ox meter and check her oxygen level during sleep (they are very cheap these days, non invasive, simple to use and she will even know that you are checking it). Let her doctor know if her O2 levels are low during sleep and let them guide you from there. I hope that this helps and please take these for what they are...suggestions and I wish her and you the best.

---------- Post added May 17th, 2013 at 12:29 PM ----------

Yes, I think the bottom line is that she needs a follow-up appointment with her doctor, and you need to tell him about her confusion problems. Confusion can have so many sources, it's hard to know where to begin . . . infection, as mentioned, hypoxemia or hypercapnia, many medications, and electrolyte imbalances are only part of the list. If your mother had a catheter in during her hospitalization, urinary tract infection is certainly a possibility. New medications need to be scrutinized, and electrolytes should be checked, as I'm certain she got IV fluids while she was ill.

In addition, serious illness can really take a toll of the functional status of elderly people. Folks who have been compensating effectively for declines in strength, coordination or cognitive ability can reveal the underlying issue when illness reduces their ability to cope. Sometimes this gets better over time, and sometimes people never get back to the level of function they had before the incident.

But this does deserve evaluation by her physician. There may be a simple, treatable cause.

I'm in 100% agreement with this.

 

[lindenbruce]

Thanks folks. I will look into a CO2 monitor. She was tested for a urinary tract infection at the hospital and it was negative. She did have a catheter when she was in the ER the first evening. But after that she was using the bedside ca-mode. She was on IV fluids and anti-biotic as well. Once she came home she was on a seven day course of oral antibiotics as well. She is not showing any signs of fever currently. I am using an o2 meter to check her O2 levels and for the most part the last four or five days she is in the 91-96 range. Today she started taking off her O2 line and left it lying on the floor twice. I took the opportunity to check her blood O2 when I discovered her lapse and it was 93. She does not snore, but when I check on her during the night she is breathing through her mouth and not her nose. I have talked to her about this and working with her to be more conscious of breathing through her nose. She may need to use a CPAP I agree. I used one myself for a year before finally having surgery.

Thanks for the input. B.

 

[Duke Dive Medicine]

Bruce, sorry to hear about your mom. Just picking up on your post this morning, but can you confirm that this is CO2 (carbon dioxide) and not CO (carbon monoxide)?

If it's CO2, just from what you've posted this is sounding like a COPD (chronic obstructive pulmonary disease) exacerbation possibly complicated by infection. Did they rule out pneumonia? Did they do blood cultures? Is she on antibiotics?


Best regards,
DDM

 

[lindenbruce]

Yeah, it's CO2. She does have COPD and Emphysema being a life long smoker. She was on antibiotics via IV in the hospital and oral after discharge. Her lungs are clear now but were wet sounding in the hospital several weeks ago. She was treated for pneumonia even though chest x-rays did not show anything in her lungs and an official diagnosis of pneumonia was never given. But they could hear the congestion in her lungs. Blood tests revealed an infection, but where exactly it was they never found out. She has cysts on her kidneys that turned out to be benign. They found spots in her lungs but said they were nothing to worry about and were typical for a smoker, but did say to get a follow-up x-ray in a year.

She had another really bad spell of confusion Thursday morning that lasted for about 5-6 hours which started in the morning. She was a little more cognitive later in the day and evening. She had a decently healthy day Friday and a great day yesterday. Took her to her PCP on Friday. They did more labs which I'm waiting on the results. Her PCP put in an order for a back pack O2 device so she can get outside and move around more. The PCP also put in an order for physical therapy too which should start soon and help her build up some strength. The PCP said to check her CO2 levels they have to do a blood gas test, which they can't do at the clinic where her PCP is at. So what to do there I don't know.

Last night and this morning I found her without her O2 several times. She is on a concentrator and receiving O2 via a nasal cannula. She was breathing room air for an unknown amount of time when I found her. Took the opportunity to check her Pulse Ox and it was 91 the first time and 98 the second time I found her without her O2. So that's encouraging that her O2 levels on room air were in the 90's. It had been in the mid 80's before. But also annoying she is being stubborn and taking off her O2.

She is feeling good again today. So it seems as though she may be a CO2 retainer and we need to work on her breathing while maintaining O2 supplementation for a few more months 24/7. Then maybe we can hopefully reduce that to night time only use. But it's a wait and see thing. When I get her labs back I will report. B