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Year 4 - Toxicology > Lecture 7 - Salicylates > Flashcards

Lecture 7 - Salicylates Flashcards

1
Q

Describe absorption of salicylates

A

very well absorbed from the stomach and small intestine

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2
Q

What is the peak time for immediate release?

A

30 min (within 1 hour)

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3
Q

What is the peak time in OD?

A

4-6 hours (or longer)

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4
Q

What factors affect absorption?

A
  • formulations (effervescent, EC)

- pylorospasm (delay of passage of stomach contents into duodenum)

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5
Q

Describe how Vd of salicylates changes in overdose

A
  • small Vd

- increases in OD

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6
Q

Describe how protein binding of salicylates changes in overdose

A
  • high protein binding

- decreases in OD

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7
Q

Describe the elimination of salicylates

A
  • First order kinetics
  • 5 pathways of elimination
  • Liver metabolism
  • Renal elimination (if we aklynize the urine, we create iron trapping and impair reabsorption of the drugs)
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8
Q

Describe how half life changes in overdose

A
  • normally 2-4.5 hours

- 18-36 hours in OD

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9
Q

What is therapeutic dose for adults?

A

325-650 mg (4-6 times/day)

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10
Q

What is therapeutic dose for children? (>12)

A

10-15mg/kg (4-6 times/day)

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11
Q

What is mild intoxication?

A

150-200 mg/kg

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12
Q

What is severe intoxication?

A

300-500 mg/kg

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13
Q

What is potentially lethal intoxication?

A

500 mg/kg

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14
Q

What is chronic intoxication of salicylates?

A

> 100mg/kg/day for 2 or more days

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15
Q

What serum levels indicate toxicity in acute OD?

A

> 90-100mg/dL

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16
Q

What are chronic therapeutic values?

A

10-30 mg/dL

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17
Q

What level is considered serious when combined with acidosis and altered mental status?

A

> 60 mg/dL

18
Q

Describe the central stimulation of the respiratory centre

A
  • Hyperventilation
  • Respiratory alkalosis
  • Dehydration
19
Q

How much bicarbonate do you need?

A

replacement of 2-3 mEq/L of plasma bicarbonate in toxic concentrations

20
Q

Salicylate overdose interferes with ____ cycle

A

Krebs

21
Q

Salicylate toxicity causes ____ _____

A

metabolic acidosis

22
Q

How does salicylate toxicity affect blood glucose?

A

hyper and then hypoglycemia

23
Q

Salicylates can cause ____ and _____ edema

A

cerebral and pulmonary

24
Q

What renal effects does salicylates have?

A
  • tubular damage

- proteinuria

25
Q

Salicylates have ototoxicity. What does this cause?

A
  • tinnitus

- hearing loss

26
Q

Describe the acute salicylate toxicity

A
  • vomiting
  • hyperpnea
  • tinnitus
  • lethargy
  • mixed respiratory alkalosis and metabolic acidosis
  • coma
  • seizures
  • hypoglycemia
  • hyperthermia
  • cerebral and pulmonary edema
27
Q

Why don’t we want to cause emesis?

A

tend not to intubate patients bc the hyperventilation is actually helping to counteract the metabolic acidosis (gastric lavage is not good then?)

28
Q

Describe chronic toxicity

A
  • ingestions of more than 100mg/kg/day for 2 days or more
  • elderly
  • slow on-set
  • less severe appearance
  • misdiagnosis
  • hearing loss and tinnitus
  • n/v
  • dyspnea, hyperventilation
  • hyperthermia
  • neurologic manifestations (confusion, agitation, seizures, coma)
  • cerebral and pulmonary edema (more common)
29
Q

Describe who is more at risk of acute salicylate poisoning

A
  • younger
  • usually intentional overdose
  • easily recognized
  • no other disease states
  • suicidal ideation is typical
  • serum concentration has a marked elevation
  • mortality is uncommon if properly diagnosed and treated
30
Q

Describe who is more at risk of chronic salicylate poisoning

A
  • older
  • therapeutic error; iatrogenic
  • frequently unrecognized
  • underlying disorders (chronic pain)
  • no suicidal ideation
  • intermediate elevation in serum concentration
  • high mortality (25%) because it’s unrecognized
31
Q

Describe the management of salicylate toxicity

A
  • emergency management
  • lab tests (salicylates, arterial blood gases, electrolytes)
  • monitoring
32
Q

What are some interventions we can use for salicylate poisoning?

A
  • gastric emptying
  • AC
  • sodium bicarbonate (to counteract the acid)
  • urinary alkalization (ion trapping of salicylates in urine)
  • hemodialysis
  • hemoperfusion
  • MDAC
  • CVVHF (continuous venovenous hemofiltration)
33
Q

Is emesis a good idea?

A

if lots is still in the stomach - yes

*however there is a risk of seizures and aspiration pneumonitis

34
Q

Is gastric lavage a good idea?

A

useful if drug is still in the stomach

35
Q

What dose of activated charcoal do you give?

A

Very large doses (300-600g) with large ingestions (30-60g)

  • 25-50g of AC at 3-5 hour intervals
  • whole-bowel irrigation
36
Q

Describe sodium bicarbonate for correction of metabolic acidemia

A
  1. 5-2 mEq/kg bolus

* for salicylates OD: bring pH to 7.4-7.5

37
Q

Describe sodium bicarbonate to obtain urinary alkalization

A

as continuous titration over 4-8 hours to get pH 7.5-8

*44-100 mEq in 1L (5% dextrose in 0.25% normal saline) at 150mL/h

38
Q

How will we treat hypokalemia?

A

30-40 mEq potassium/L

39
Q

Is hemodialysis good for removing salicylates?

A

Yes, very effective

  • remove salycilates
  • correct acid/base abnormalities
  • correct fluid abnormalities
40
Q

When is HD indicated for salycilate toxicity?

A
  • acute ingestion serum levels > 100 mg/dL, with severe acidosis or other manifestations of toxicity
  • chronic intoxication serum levels higher than 60 mg/dL
  • renal failure (obvs)
  • deterioration (CNS, acute lung injury, hepatic compromise with coagulopathy)

Year 4 - Toxicology (24 decks)

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