• 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

• 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

• 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

• For further reading...

  Review and Recommendations for HD in Salicylate poisoning
  Extracorporeal Treatments in Poisoning Working Group Guidelines
  
  

  Posted 09/15/16 11:32:40 AM by Anna Krigel

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