OVERVIEW
- aspirin
mechanisms of toxicity: acid-base disturbance, uncoupling of oxidative phosphorylation, disordered glucose metabolism
CLINICAL FEATURES
- nausea, vomiting, abdominal pain, tinnitus
- deafness, hyperventilation, flushed skin, sweating, hyperthermia
- may aspirate, pulmonary oedema and ARDS
- cardiovascular instability
INVESTIGATIONS
- high salicylate level (mild – < 500mg/L, moderate 500-750mg/L, severe > 750mg/L)
- metabolic acidosis – lactate
- respiratory alkalosis – hyperventilation
- ECG: widened QRS, AV block, ventricular arrhythmias
- hypoglycaemia or hyperglycaemia
- hypokalaemia
- hypoprothrombinaemia
- thrombocytopaenia
- DIC
- renal failure
MANAGEMENT
Resuscitation
- maintain intravascular volume
- intubate if unrousable
Acid-base and Electrolyte Abnormalities
- glucose infusion if hypoglycaemic
- correct electrolytes
- vitamin K if hypoprothrombinaemia
- sodium bicarbonate for severe acidosis
- no role for forced alkaline diuresis any more
- dialysis in moderate to severe cases
Specific Treatment
- supportive care
Underlying Cause
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