ASA\Salicylates

Question 1

ASA\Salicylates

Pathology:

Answer 1

Respiratory alkalosis (central respiratory stimulation) and metabolic acidosis (uncoupling of oxidative phosphorylation), anion gap
acidosis

Question 2

ASA\Salicylates

ASA/Salicylates Acute overdose S/S and ranges.

Answer 2

n/v, tinnitus, resp alk, met acid, cerebral edema, seizures, ARDS, positive urine ketones
ASA toxicity:
< 150 mg/kg = mild
150-300 mg/kg = mod
300-500 mg/kg = severe
> 500 mg/kg = lethal

Question 3

ASA\Salicylates

ASAP:

Answer 3

ABCs, IV, O2, monitor, VS, EKG

Question 4

ASA\Salicylates

Hx:

Answer 4

ASA ingestion or ASA containing meds(common in multi-ingestions), use of BenGay, Icy Hot, oil of wintergreen(contain huge
amounts of ASA), tinnitus

Question 5

ASA\Salicylates

Exam:

Answer 5

Early: ↑temp, ↑RR, ↑HR, ↓BP,arrhythmias, N/V, diaphoresis; late: coma,sz, pulm edema, DIC

Question 6

ASA\Salicylates

Labs:

Answer 6

ASA and coags (most important),also: APAP, EtOH, CBC, BUN/Cr, lytes, gluc, LFTs, ABG, UA, UDS, urine pH,hCG; levels of any other known drug ingested; T&C if GI bleed

Question 7

ASA\Salicylates

Treatment:

Answer 7

Urinary alkalinization to pH >7.5 with bicarb to increase urinary excretion via ion trapping
NaHCO3 2-3 amps (1-2 mEq/kg) IV,then 3 amps in 1L D5W @ 1.5 x maintenance, goal: urine pH 7.5-8.0
1 amp bicarb= 50m Eq (8.4%)

Question 8

ASA\Salicylates

If hypokalemic…

Answer 8

add 20-40 mEq K to fluids
K+ administration to correct losses once UOP adequate to allow urinary alkalinization

Question 9

ASA\Salicylates

If respiratory fatigue…

Answer 9

Intubate PRN but must hyperventilate to match pt’s own compensation

Question 10

ASA\Salicylates

Dialysis if…

Answer 10

Severe acidosis, severe end-organ damage or ASA > 90 mg/dl, coma, rising levels despite alkalinization, risk of volume overload