Accidents/Poisoning

Question 1

Children who have ingested more than how much salicylate e.g. aspirin should go to hospital?

Answer 1

> 125mg/kg

Question 2

Symptoms/complications of salicylate e.g. aspirin toxicity

Answer 2

Mild - N+V, dizziness, lethargy
Severe - hypokalaemia, pulmonary / cerebral oedema, seizures, confusion, coma, hyperpyrexia, ventricular arrhythmias, asystole, deafness, DIC, rhabdo, hypo/hyperglycaemia

Question 3

Effect of salicylate e.g. aspirin OD on acid/base status

Answer 3

Initially hyperventilation from direct resp-centre stimulation in brain –> respiratory alkalosis –> progressive metabolic acidosis due to
1. disruption of Krebs cycle so incr in lactate/pyruvic acid
2. incr in ketones due to incr in fatty-acid metabolism

Question 4

When should plasma salicylate conc be checked?
Other investigations?

Answer 4

Symptomatic - 2hrs post ingestion
Asymptomatic - 4hrs
Other: blood gas, urinary pH, FBC (thrombocytopenia), U+Es (hypoK), ECG

Question 5

Management of salicylate OD

Answer 5

Activated charcoal if <1hr
Gastric lavage <1hr
Correct hypoK
Urinary alkalinisation by giving sodium bicarb
Haemodialysis if severe