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Considerations with potassium level disturbances (hyper/hypokalemia):
- ins - oral ingestion in outpatients, consider IV administration in inpatients
- outs - GI (diarrhea) or urinary excretion
- shifts - occur in acid/base disorders, and promoted by insulin and adrenergic tone
Posted 09/15/16 09:42:26 AM by Anna Krigel
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Salicylate toxicity
- inhibition of COX -> decreased synthesis of prostaglandins, prostacyclin, and thromboxanes -> platelet dysfunction and gastric mucosal injury
- stimulation of chemoreceptor trigger zone in medulla -> nausea/vomiting
- activation of respiratory center in the medulla -> hyperventilation and respiratory alkalosis (can lead to potassium shift into cells causing hypokalemia and renal bicarb wasting causing low serum bicarb)
- interference with cellular metabolism -> metabolic acidosis
Posted 09/15/16 09:46:27 AM by Anna Krigel
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Acute management of salicylate toxicity
- Intubation should be avoided as much as possible -> brief period of sedation and paralysis that takes place during intubation can cause a transient acidemia and promote salicylic acid crossing the blood-brain barrier worsening toxicity
- Aggressive volume resuscitation
- Activated charcoal if within two hours of ingestion
- Alkalinization of serum and urine with serum bicarb with careful monitoring to avoid severe alkalemia
- Hemodialysis -> indicated in patients with AMS, pulmonary edema with respiratory distress, cerebral edema, AKI with eGFR<45, fluid overload that prevents the administration of sodium bicarb, severe acidemia, and severe elevation in salicylate level (>80 or >90 depending on renal function)
Posted 09/15/16 10:56:10 AM by Anna Krigel
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For further reading...
Posted 09/15/16 11:32:40 AM by Anna Krigel
Created by Christopher Kelly
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.