Poisoning, Salicylate

Mixed

Step 1: View clinicals

A 70 year old man presents with altered behavior and slurred speech for one day. He was previously well, except for longstanding osteoarthritis, for which he consumed over-the-counter analgesics regularly. A full blood count, random blood glucose, serial ECGs, chest radiograph, urinalysis and liver profile are normal.


Step 2: Order all relevant investigations

CT brain

The non contrast CT of the brain appears normal, with no evidence of hemorrhages, infarcts or cerebral edema.

Arterial Blood Gases

pH: 7.51 (7.35 - 7.45) paCO2: 12 mmHg (35 - 45) paO2: 115 (> 75 on room air) HCO3: 9 mmol/L ABE: -12.6

Renal functions & electrolytes

Urea: 20 mg/dL (0 - 50) Creatinine: 1.4 mg/dL (0.5 - 1.5) Na+ 138 mmol/L (135 - 145) K+ 3.1 mmol/L (3.5 - 5) Cl- 108 mmol/L (95 - 110)

Toxicology screen

Acetaminophen: not detectable Benzodiazepines : not detectable Barbiturates : not detectable Tricyclic antidepressants : not detectable Salicylates: 50 mg/L (2 - 29)


Step 3: Select appropriate management

IV Sodium Bicarbonate
Activated Charcoal
Hemodialysis
IV Dextrose


Score: ★★☆