Sunday, February 02, 2014

Salicylate toxicity

A great resource is located here at the American College of Medical Toxicology web site. A related post at Academic Life in Emergency Medicine elaborates on some of the key points.

Involve nephrology and poison control early.

Volume depletion in the salicylate intoxicated patient can be taken for granted. Replete appropriately.

Know the indications for hemodialysis.

Maintain alkalemia (pH 7.50-7.55) and alkaline urine pH.
These measures keep salicylate out of the CNS and enhance renal excretion, respectively.

Intubate if you must but be aware of, and prepared for, the hazzards.
Remember the goal of alkalemia. Neither the person bagging a sedated or paralyzed patient nor the mechanical ventilator can do as reliable a job of hyperventilation (to preserve a normal, or better yet, alkaline, serum pH) as can the brain of an awake patient. The pH may fall precipitously around the time of intubation resulting in a sudden influx of salicylate into the CNS, which can be catastrophic.

No comments: