[A case of emergency admission for CO2 narcosis in a patient with amyotrophic lateral sclerosis]

Masui. 1995 Sep;44(9):1246-9.
[Article in Japanese]

Abstract

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 (PaO2; 32 mmHg, PaCO2; 127 mmHg). We diagnosed as CO2 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 CO2 narcosis without any pulmonary disorder, we have to suspect neuromuscular diseases, e.q. ALS. In some of such cases, mechanical ventilation supports social rehabilitation.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Aged
  • Amyotrophic Lateral Sclerosis / complications*
  • Amyotrophic Lateral Sclerosis / diagnosis
  • Carbon Dioxide / blood*
  • Dyspnea / blood
  • Dyspnea / etiology*
  • Dyspnea / therapy
  • Electromyography
  • Emergencies
  • Humans
  • Male
  • Ventilators, Mechanical

Substances

  • Carbon Dioxide