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Salicylate Overdose

Salicylate Overdose:

Fatal aspirin (ASA) intoxication, in adults, can occur after the acute ingestion of how much ? * 10-30 gm ASA
Assessment of Severity of Salicylate Intoxication = ? * Mild = N/V/D and Hyperpnea... * Mod = Fever.... * Severe = Coma, convulsions, hallucinations
What is the difference between hyperpnea and hyperventilation = ? *hyperventilation (rapid breathing) and hyperpnea (deep breaths)
How to calculate an Anion Gap = ? * Anion Gap = Na⁺ - (Cl¯ + HCO₃) = 12 +/- 2
Causes an Elevated Anion Gap ? * M = Methanol ....U = Uremia ....D = DKA ....P = Paraldehyde ....I = Isoniazide ....L = Lactic acidosis ....E = Ethanol ....R = Rhabdomyolysis ....S = Salicylates
ABG: Sodium: 142.... Cl: 100....BiCarb: 14.... ...pH: 7.46 (7.35-7.45) ...pCO₂: 27 (35-40) ...pO₂: 107 (70-100) ...HCO₃: 19 (21-28).... What does she have and what is her AG ? * She is alkolotic.... * b/c her PCO2 < 40, hers is 27, she has a Resp. Alk.... * AG = 142- (100+14) = 28
Evaluate the bicarb gap = ? * Corrected Bicarb = (measured AG-normal AG) + HCO3+... 28-12 +14 = 30 .... * she has a high anion gap met acidosis with resp alkolosis
How we get Resp. Alkalosis = ? * Hyperpnea --> loss of CO2 = Resp. Alk (what we see first in Salic. OD)
How we then get Met. Acidosis = ? * Ox. Phos is uncoupled, see an increase in Glycolysis --> increase in Lactic Acid formation and inhibiton of TCA (krebs Cycle) = High AG gap Met. Acidosis
Most Toxic Formulation of Salicylates = ? * Methylsalicylate (Oil of Wintergreen).... * High concentration in a low dose (Bengay is an example)
When is Subsalicylate more toxic ? * when pH is low... * when urine pH increases, so does the excretion of the drug
Increases salicylate toxicity because they result in greater distribution of salicylate to tissues = ? * Dehydration, hyperthermia, and chronic ingestion
Differential Diagnosis = ? * other alcohol/substance abuse/use, anxiety, asthma, DKA, lactic acidosis,
Goals of Treatment = ? * Rapid assessment and stabilization of airway, breathing, circulation ... * Good History while getting labs... * correct fluids/hypok... * prevent entry in to CNS and start removing drug (AC immediately)
What we should try to avoid ? * Intubation of a patient (causes salic. to rush into CNS and get met. acidosis)
Treatment of urine and what maintenance fluid to give ? * alkalinize the urine = Ideally want urine pH between 7.5-8.0 and Goal urine output: 1-2 mL/kg/hr..... * Give a solution consisting of 1 liter of D5W (dextrose), 3 amps NaHCO3, and 40 mEq KCl at 1.5-2 times the maintenance iv fluid rate
Drug to NEVER give ? * acetazolamide to Alk the urine (B/C causes acidemia of the Blood)
Indications for Hemodialysis = ? * Not 1st line tmt though…. * Renal insufficiency, fluid overload, clinical deterioration in spite of other measures, resp failure, you decided to vent them
Chronic Salicylate Poisoning = ? * Occurs when > 100 mg/kg/d ingested for 2 or more days ..... * Common in Old and Young..... * Initial key to diagnosis: unexplained high anion gap
Created by: thamrick800