SALICYLATES(ASA) OD

Question 1

Dextrose 5% WIth 3 amps of sodium bicarb

Answer 1

• The dextrose will treat the central nervous system
  (CNS) hypoglycemia.
• The sodium bicarb will help correct the metabolic
  acidosis.
• Potassium may be supplemented if hypokalemia is
  present.

**Patients with salicylate toxicity are volume depleted due to hyperventilation, fever, and increased metabolic activity. **
hypoglycemia
tachycardia
hypokalemia
coagulopathy

Question 2

Mechanicle Ventilation

Answer 2

• Mechanical ventilation, while not ideal, may be
  required.
• Consider a bolus of 1 to 2 mEq/kg of sodium
  bicarbonate at the time of intubation to temporize
  the patient’s pH until hyperventilation can be
  resumed on the ventilator.
• Mechanical ventilation will not be able to compensate
  for the metabolic acidosis as well. Arrangements for
  emergent hemodialysis should be arranged following
  intubation.
• Patients may also experience respiratory distress
  secondary to pulmonary edema following fluid
  resuscitation.

Patients with severe toxicity will eventually fatigue and be unable to maintain respiratory compensation for the metabolic acidosis.
early respriatory alkalosis
metabolic acidosis
altered mental status

Question 3

Activated Charcoal

Answer 3

• Activated charcoal has been shown to decrease salicylate levels. However, no morbidity or mortality benefit has been shown.
• Gastric lavage may be considered if the patient presents after acute ingestion of enteric-coated aspirin. If there is any concern for aspiration, these options should be avoided.

**Following initial stabilization, attempts should be made to decrease the serum salicylate levels. **
gi irritation
ketosis
tinnitus

Question 4

Fluid resuscitation, serum alkanization, hemodialysis

Answer 4

• Fluid resuscitation and serum alkalization will increase salicylate elimination.
• Hemodialysis can also accomplish this. Indications for hemodialysis include
  
  • severe acidosis or hypotension despite fluid
    resuscitation;
  • salicylate levels are greater than 100 mg/dL,
  • mechanical ventilation,
  • or end-organ damage.
    Common signs of end-organ damage in salicylate toxicity include seizures, rhabdomyolysis, pulmonary edema, cerebral edema, and renal failure. Hemodialysis removes salicylates and lactate, which should improve the patient’s metabolic acidosis.
    hyperthermia

Question 5

Benzodiazepines

Answer 5

• Seizures should be treated with benzodiazepines.
  
  • Glucose should also be administered as CNS
    hypoglycemia may be present.
    -Expect the patient’s metabolic acidosis to be worse
    following a seizure and consider administering a
    bicarbonate bolus.