Aspirin overdose antidote3/30/2023 ![]() Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. ![]() Next Year: to Rocky Mountain Poison and Drug Center, Denver CO Toxicology Fellowship References: Guest Post By:Ĭhief Resident- San Antonio Military Medical Center- PGY 3 Timely hemodialysis for intubated salicylate overdose patients decreases mortality.”Ĭlinical Take Home Point: In patients requiring intubation from acute salicylate toxicity, hemodialysis should be considered as part of management, as this is associated with decreased mortality. Mortality increases with the measured serum salicylate level. “Survival was decreased in these patients if hemodialysis was not performed. As this paper is limited due to the size of the population and its retrospective nature, consultation with your local poison center is strongly encouraged to help guide management.It is therefore important to consider bicarbonate therapy and hemodialysis in these situations. The issue with intubation is the inability to keep up with the hyperventilation necessary to avoid hypercapnia and worsening acidosis, both of which can lead to cardiac arrest. In patients with worsening clinical status, intubation maybe a necessary evil.This fact should emphasize the importance of checking serial levels of salicylate poisoning cases. Two of these patients died and four had HD performed. In this study, there were 9 cases of patients with an initial serum salicylate level of <50mg/dL and subsequently increased to a level above toxic thresholds. Measured serum salicylate levels can be erratic due to multiple factors.May have missed some cases of salicylate toxicity) Inconsistent poison center data acquisition (i.e.Extracted data may have been incomplete.Unable to distinguish acute vs chronic salicylate toxicity.Inclusion of patients that ingested multiple medications.Can only demonstrate association, not causation) Measures an important, clinically relevant endpoint (i.e.Queries a nationally established and reputable data base.Addresses an important option in managing salicylate poisoning.6 patients did not complete HD, all suffering cardiac arrest.Of the 15 fatal cases, 11 patients (73.3%) did not receive hemodialysis.41 of those 56 patients survived (73.2%).Lack of association with salicylate intoxication.Patents were included if salicylate levels >50mg/dl.Patients of all ages recorded as having ingested salicylate and salicylate containing medications resulting in intubation.Of those cases, investigators noted which patients received hemodialysis as part of their management.Identified cases of salicylate toxicity (level >50 mg/dl) from the Illinois Poison Center associated with the National Poison Data System (NPDS) treatment code of ASPIRIN and INTUBATION.Hemodialysis is another option in management of salicylate toxicity to help correct acid-base abnormalities and directly remove salicylates from the blood stream. In addition to ventilation management, other therapeutic options to help manage acute salicylate toxicity include alkalization of the serum to prevent conversion of salicylates to its non-ionized form, which easily crosses the blood brain barrier and can lead to cerebral edema and end organ damage. Despite this, intubation in many cases of severe salicylate toxicity is necessary. Once intubated, the peri-intubation minute ventilation, typically, cannot be matched by the ventilator, thus taking away the patient’s physiologic mechanism of compensation for the metabolic abnormalities associated with salicylate toxicity leading to further clinical deterioration. Patients with tachypnea are able to compensate for the profound metabolic acidosis that can develop from salicylate poisoning. Intubation has unique implications in patients with acute salicylate toxicity. As the severity of toxicity increases, the need for airway protection through intubation and mechanical ventilation becomes more profound. This is then followed by an anion gap metabolic acidosis.ĭue to the metabolic derangements induced by salicylates as well as salicylate’s direct stimulation on the respiratory centers of the brain, patients can present with profound tachypnea, fever and even altered mental status. Initially, as salicylates are metabolized, they can induce a respiratory alklalosis. They are readily available, and in the setting of an overdose, can be fatal. Background: Salicylates are common substances that can be purchased over the counter.
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