A case of emergency admission for CO2 narcosis in a patient with amyotrophic lateral sclerosis
Shichinohe, Y.; Omote, T.; Arakawa, J.; Takahashi, H.; Ujike, Y.; Namiki, A.
Masui. Japanese Journal of Anesthesiology 44(9): 1246-1249
1995
ISSN/ISBN: 0021-4892 PMID: 8523659 Document Number: 443170
A 68-year-old man with severe dyspnea was admitted as an emergency case. He had no past history of any respiratory or neuromuscular diseases. Immediately after insufflation of oxygen, respiratory arrest occurred. The blood gas analysis showed hypoxemia and severe hypercapnia (Pa-O2; 32 mmHg, Pa-CO-2; 127 mmHg). We diagnosed as CO, narcosis, and he was treated with a respirator in the ICU. He showed nonflaccid bilateral diaphragmatic paralysis and muscle atrophy of the upper extremities. As the EMG showed giant spikes of neurogenic pattern, he was diagnosed as ALS. Weaning from the respirator failed because of his respiratory muscle fatigue. He was given rehabilitation during the day time and ventilatory support with the respirator during the night. We conclude that if we meet with an emergency patient with CO, narcosis without any pulmonary disorder, we have to suspect neuromuscular diseases, e.q. ALS. In some of such cases, mechanical ventilation supports social rehabilitation.