What is the role of blood studies in the workup of smoke inhalation injury?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Electrolyte testing can identify an anion gap acidosis. In patients who require large-volume fluid resuscitation, measure electrolytes at regular and frequent intervals to monitor for the electrolyte abnormalities that may occur in these patients. Use results to adjust both fluid and electrolyte replacement.

Blood urea nitrogen (BUN) and creatinine levels should be obtained for baseline renal function determination in patients in shock or with rhabdomyolysis. Patients with large cutaneous burns, crush injuries, or prolonged immobilization should have their serum creatine kinase (CK) checked and, if appropriate, urine myoglobin.

Exposure to zinc oxide warrants baseline liver function tests on initial presentation. Liver function should be followed over the course of hospitalization if exposure is severe enough to warrant admission.

Thermal degradation products of various compounds, including phosphorus-based fire retardants, are capable of impairing cholinesterase activity. A prospective study measured serum erythrocyte cholinesterase activity at the scene of residential fires for 49 victims. A significant lower level of cholinesterase activity was noted in these patients as compared to controls. Obviously, further investigation into the clinical significance of this lower enzymatic activity is needed before it can be used clinically.

Lead-containing paint is common in structures built before 1977, and this element can become aerosolized and absorbed directly into the bloodstream from the lungs. While it is true that severe smoke inhalation has been shown to increase serum lead levels more than 2-fold, no evidence suggests that these elevations are clinically relevant. [41]


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