S15C182 - ASA and salicylates

Question 1

When does ASA levels peak in an OD?

Answer 1

-18-24h

Question 2

ASA Pathophys

Answer 2

• as pH decreases and becomes more acidic, more ASA becomes nonionized and therefore more can cross the BBB
• metabolic acidosis, respiratory alkalosis (as well a met alk occurs from volume contractn)

Question 3

ASA Sx

Answer 3

• n/v
• increased RR stimulated directly by ASA (with severe OD, RR is actually decreased)
• tinnitus, sweating
• chronic: fever, hyperventilation
• severe: AMS, Sz, renal failure, shock, arrhythmia
• chronic: incr RR, tremor, papilledema, agitation, paranoia, impaired memory, confusion, stupor or unexplained pulmonary edema (higher morbidity than acute toxicity)

Question 4

Dx ASA toxicity

Answer 4

-do ASA serum levels q1-2h until concentrations decline

Question 5

ASA OD w/u:

Answer 5

-ASA levle, lytes, glucose, BUN, Cr, ABG, CXR, AXR, ECG, CBC, Ca, u/a, urine pH

Question 6

Tx of ASA OD

Answer 6

• ABCDE
• GI decontamination
• Fluid/lyte replacement
• Ion trapping (alkalanize urine)
• Dialysis

Question 7

Urine alkalanization

-

Answer 7

• target u/o of 1-2cc/kg/h
• IV bolus NaHCO3- 1-2mEq/kg then infusion of 3 amps (50mEq/amp) added to 1L of 5% dextrose in water, start at 2-3cc/kg/h
• goal for urine pH >75
• 5% dextrose important for neural protection

Question 8

HD indications:

Answer 8

• need for resp and ventilatory support (intubated)
• deterioriation or failure to improve with alkalinization
• unable to establish alkaline urine
• renal insufficiency/failure
• severe acid/base disturbance
• AMS
• acute lung injury
• > 100mg/dL of ASA - should think of HD
• continue until asa level