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30 Cards in this Set
- Front
- Back
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_________ alone or in combination is approximately the 7th or 8th cause of death from toxic exposure
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Aspirin
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Reasons that Aspirin alone or in combination is approximately the 7th or 8th cause of death from toxic exposure
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OTC status
Available under multiple brand names |
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Brand names for Aspirin
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Anacin
Bayer Alka-Seltzer Pepto-Bismol Kaopectate Aspercreme Bengay |
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Therapeutic Use of ASA
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Effects
Analgesic Antipyretic Anti-inflammatory Anti-platelet MOA Inhibits cyclooxygenase and decreases prostaglandin production |
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Effects of ASA
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Analgesic
Antipyretic Anti-inflammatory Anti-platelet |
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MOA of ASA
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Inhibits cyclooxygenase and decreases prostaglandin production
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Therapeutic range of Acetylsalicyclic Acid
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15 to 30 mg/dL
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Therapeutic doses of Acetylsalicyclic Acid
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Children: 10 to 20 mg/kg
Adults: 650 to 1000 mg every 4 to 6 hours |
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Conversion:
Methylsalicylate 98% 1mL |
1400 mg of ASA
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Conversion:
Bismuth subsalicylate |
8.77 mg/L of salicylic acid
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Conversion:
Trolamine salicylate cream |
500 mg salicylate/10 grams
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Oil of wintergreen contains ...
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methylsalicylate
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Pharmacokinetics
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- Absorption typically rapid from stomach
- Delayed in bezoar formation - Toxic serum levels may not be reached until ≥ 4 to 6 hours - Longer half-life at toxic levels - From 2 to 4 hrs up to 20 hrs Decrease in protein binding - From 90% to 75% - Increase in Vd from 0.2 to 0.3 L/kg |
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Presentation of Acute Toxicity
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Main 3 phases
Symptoms Nausea, vomiting, abdominal pain, diaphoresis, and ringing/hissing in the ears ± hearing loss Hearing loss caused by vasoconstriction of auditory microvasculature Respiratory alkalosis Hyperventilation secondary to direct brainstem respiratory center stimulation by salicylates Metabolic acidosis with an anion gap May see mixed respiratory alkalosis or acidosis and metabolic acidosis |
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Presentation of Acute Toxicity
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Hyperthermia
Caused by uncoupling of oxidative phosphorylation Dehydration Noncardiogenic pulmonary edema Caused by increase permeability of pulmonary vasculature Dysglycemia Increased insulin secretion Decreased peripheral glucose utilization Platelet dysfunction/hypoprothrombinemia |
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Presentation of Chronic Toxicity
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Elderly population
Higher mortality because harder to recognize Same symptoms but slower onset Typically result from small increase in dose or decrease in renal function Levels do not correlate with severity 30 to 40 mg/dL may be life threatening |
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Diagnostic Test
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Serum salicylate levels
Every 2 to 4 hours until obtain two consecutive declining levels Obtain additional levels if patient’s clinical presentation worsens (e.g., bezoar) ABGs Electrolytes and glucose levels Renal and hepatic function Blood count Chest x-ray |
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Management Goals
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GI Decontamination
Correct fluid deficits Correct acid-base disorders Enhance salicylate excretion |
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Gastric Decontamination
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Activated charcoal
Reduction of toxin absorption by chemically binding (adsorbing) it to charcoal surface Binds Immediate Enteric coated Sustained-release |
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Gastric Decontamination
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Single dose activated charcoal
Dose 1-12 yrs: 1 g/kg >12 yrs: 25-50 g Mixed w/water to make slurry, shake well, administer via nasogastric tube Contraindications Ileus Watch for ASA induced decline in CNS function Increase risk of aspiration Bezoar – questionable use of MDAC |
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Gastric Decontamination
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Whole bowel irrigation
For ASA bezoar or ingestion of enteric coated/sustained release products Polyethylene glycol electrolyte solutions (GoLytely, Colyte) Administered continuously through an nasogastric tube Begin at 0.5 L/hr and titrate up by 0.5 L every 30 mins until goal of 2 L/hr Continued until rectal fluids are clear &effluent |
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Gastric Decontamination
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Whole bowel irrigation
Contraindications Bowel perforation Obstruction, ileus GI hemorrhage Intractable emesis Adverse effects Emesis Abdominal cramp Bloating Challenging to execute & monitor |
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Fluid Management
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Electrolyte replacement
10 to 20 mg/kg NS plus 20 to 40 mEq/L KCl for urine output of 1 to 3 mL/kg/hr Approximately 2 to 4 Liters in adults Hypoglycemia management Altered mental status give 50 grams IV dextrose |
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Enhanced Elimination
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Alteration of urine pH - alkalinization
Used for drugs excreted by renal route Traps drug in tubule by adjusting pH so drug is in ionized form (will not be reabsorbed by kidney) Give sodium bicarbonate IV Dose: 1 - 2 mEq/kg over 1-2 hr Do not use acetazolamide as it worsens metabolic acidosis Monitor urine pH Goal = 7.5 to 8 |
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Enhanced Elimination
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Alkalinization of urine
Adverse effects Alkalosis – monitor serum pH (≤ 7.55) Preparation of sodium bicarbonate Typically 2 to 3 ampules/pre-filled syringes (50 mEq/50 mL) in 1 L D5W 10% rule for IV fluids |
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Enhanced Elimination
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Hemodialysis
Indicated in the following: Acute level > 100 mg/dL Chronic level > 60 mg/dL Intractable acidosis Renal failure Pulmonary edema Severe CNS disturbances (seizures and coma) Endpoint Serum level < 30 mg/dL |
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NSAID Toxicity: Common Presentation
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Usually asymptomatic
GI distress Mild CNS depression |
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Atypical Presentation
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Anion gap metabolic acidosis
Propionic acids Nabumetone Respiratory depression Hypotension Hypothermia Acute renal failure Liver toxicity Severe CNS symptoms Confusion Hallucinations Seizures |
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Diagnostic Test for NSAID Toxicity
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Serum electrolytes
Renal function If respiratory or CNS symptoms present, obtain ABGs |
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Management of NSAID Toxicity
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Supportive care
GI decontamination Single dose AC Enhanced elimination for NSAIDS that undergo enterohepatic recirculation |
