aspirin/salicylate toxicity Flashcards
1
Q
products w/ salicylates
A
- GI remedies: pepto-bismol, alka-selter
- Topical balms: icy hot, bengay, oil of wintergreen
2
Q
Acute toxic dose
A
> 150mg/kg
life threatening: >500 mg/kg
- #247 tabs of 81mg, #61 tabs of 325mg #80 of excedrin
- wintergreen life-threatening doses: 20ml/4 teaspoons in adults, 5 ml/1 teaspoon for children
3
Q
Clinical pres of aspirin tox
A
- Respiratory: tachypnea
- GI: n/v/ hemorrhagic gastritis, volume depletion
- CNS: Tinnitus, AMS, seizures, hypoglycorrachia
- renal & hepatic injury, pulmonary edema
4
Q
PK of salicylates
A
- delayed, varying absorption; methylsalicylate is quick
- 50-90% protein binded, small VD (inc with metabolic acidosis/ uncoupled)
-1/2 life is 2-4 hrs, extended in overdose
5
Q
Bezoars
A
- slow, releases more drug over time
- need multiple levels showing decline & symptoms subside
6
Q
Labs with salicylate toxicity
A
- Acid/base: respiratory/mixed/both acidosis
- Electrolytes: hypo/er glycemia, inc fluids and electrolyte losses, inc anion gap
- urine: ketones present
7
Q
What is ion trapping role in salicylates
A
- ionized molecules wont cross membrane as readily
- want it to be unionized so that it can be excreted in urine
*change PH of urine
8
Q
Management of bezoars
A
- give dextrose .5 - 1g/kg
- fluid maintenance with NA bicarb
- urine pH > 7.5
- maintain K
- monitor q2-4 hrs
9
Q
when to consider hemodialysis in salicylate overdose
A
- serum level acute >100 mg/dl, chronic >60 mg/dl
- neurologic deterioration
- seixures
- acidosis <7.20
- renal failure
- pulmonary edema
10
Q
when to stop hemodialysis in salicylate overdose
A
- clear improvement in pt
- salicylate level <19
- HD completed for 4-6 hrs & levels not obtainable
11
Q
chronic salicylate overdose management
A
- airway, breathing, circulation (do not intubate)
- enhance elimination: activated charcoal 1g/kg, HD, urine pH
- treat AEs
