Salicylate Overdose:
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| Fatal aspirin (ASA) intoxication, in adults, can occur after the acute ingestion of how much ? | * 10-30 gm ASA
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| Assessment of Severity of Salicylate Intoxication = ? | * Mild = N/V/D and Hyperpnea... * Mod = Fever.... * Severe = Coma, convulsions, hallucinations
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| What is the difference between hyperpnea and hyperventilation = ? | *hyperventilation (rapid breathing) and hyperpnea (deep breaths)
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| How to calculate an Anion Gap = ? | * Anion Gap = Na⁺ - (Cl¯ + HCO₃) = 12 +/- 2
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| Causes an Elevated Anion Gap ? | * M = Methanol
....U = Uremia
....D = DKA
....P = Paraldehyde
....I = Isoniazide
....L = Lactic acidosis
....E = Ethanol
....R = Rhabdomyolysis
....S = Salicylates
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| 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
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| 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
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| How we get Resp. Alkalosis = ? | * Hyperpnea --> loss of CO2 = Resp. Alk (what we see first in Salic. OD)
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| 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
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| Most Toxic Formulation of Salicylates = ? | * Methylsalicylate (Oil of Wintergreen).... * High concentration in a low dose (Bengay is an example)
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| When is Subsalicylate more toxic ? | * when pH is low... * when urine pH increases, so does the excretion of the drug
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| Increases salicylate toxicity because they result in greater distribution of salicylate to tissues = ? | * Dehydration, hyperthermia, and chronic ingestion
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| Differential Diagnosis = ? | * other alcohol/substance abuse/use, anxiety, asthma, DKA, lactic acidosis,
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| 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)
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| ANTIDOTE FOR SALICYLATE POISONING = ? | * NONE
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| What we should try to avoid ? | * Intubation of a patient (causes salic. to rush into CNS and get met. acidosis)
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| 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
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| Drug to NEVER give ? | * acetazolamide to Alk the urine (B/C causes acidemia of the Blood)
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| 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
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| 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
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