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CPC Case Conclusion

CPC Case Conclusion. Aaron Schneir MD San Diego Division- California Poison Control System UC San Diego Medical Center. CPC Discussion. The family brought in an empty bottle of…. Testing of previously drawn blood revealed a …… level of …. Aspirin. Salicylate level of 99 mg/dL!!!.

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CPC Case Conclusion

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  1. CPCCase Conclusion Aaron Schneir MD San Diego Division- California Poison Control System UC San Diego Medical Center

  2. CPC Discussion The family brought in an empty bottle of…. Testing of previously drawn blood revealed a …… level of …..

  3. Aspirin Salicylate level of 99 mg/dL!!!

  4. CPCFurther Information History- suicide note with reference to ingesting aspirin; no history of excessive consumption of ephedrine-containing weight loss supplement Laboratory • Initial CK- 31,000 (explains AST elevation) • Comprehensive tox screen- ephedrine • Repeat UA- ketones present

  5. CPCWhat about the initial ECG? Prolonged conduction secondary to hyperkalemia

  6. ECG #2 (post bicarb)

  7. Rapid Urine Toxicology ScreenAmphetamines as a class

  8. Major clues to case 1) Hyperthermia 2) Worsening of condition with intubation

  9. Aspirin and HyperthermiaUncoupling of oxidative phosphorylation Electron transport continues but without the coupled ATP synthesis. Result is heat generation.

  10. Rhabdomyolysis and Salicylates Rhabdomyolysis = diffuse skeletal muscle necrosis Consequence of rhabdomyolysis • Acute tubular necrosis • Hyperkalemia

  11. Salicylates and Rhabdomyolysis Mechanism 1) hyperthermia 2) increased muscular metabolism 3) compression of muscle 4) direct effect?

  12. Acidemia and Salicylates pK = pH at which equal concentrations of an acid and its conjugate base are present pKa of salicylate = 3.5

  13. Importance of Minute Ventilation with Salicylates Presence of acidemia allows for salicylate to penetrate brain CNS salicylate correlates with morbidity and mortality Essential to maintain minute ventilation to prevent acidemia

  14. Improvement in Outcome 1) initial suspicion of salicylate overdose 2) attention to acid-base status and corresponding minute ventilation 3) rapid initial cooling 4) hemodialysis

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