TOX TABLES
Salycilates (Aspirin, Oil of Wintergreen)
IMPORTANT SHIT
Toxic dose probably >150 mg/kg, >500 mg/kg = fatal
Salyclism - N+V, vertigo, tinnitus, seizures, hyperthermia, dehydration, coma CVS collapse
Initial Resp alkalosis >> HAGMA
Role of Alkalinisation
Systemic - alkalosis promotes ionised form. Acidosis causes non-ionised form which crosses BBB causing neurotoxicity
Urine - Alkalinisation promotes ionised form >> Decreased reabsorption
Salyclism - N+V, vertigo, tinnitus, seizures, hyperthermia, dehydration, coma CVS collapse
Initial Resp alkalosis >> HAGMA
Role of Alkalinisation
Systemic - alkalosis promotes ionised form. Acidosis causes non-ionised form which crosses BBB causing neurotoxicity
Urine - Alkalinisation promotes ionised form >> Decreased reabsorption
SPECIFIC ANTIDOTE
Urinary Alkalinisation
Sodium bicarbonate 8.4% 1 mL/kg up to 100 mL (1 mmol/kg up to 100 mmol) intravenously, as an initial dose
FOLLOWED BY
sodium bicarbonate 25 mmol/hour by intravenous infusion.
Glucose
Intubate and hyperventilate - acidosis on induction is fatal - bag through apnoea
Dialysis - ARF, Acidosis, Toxic, Level >4 despite treatment
Endpoints: Urine pH >7.5
Sodium bicarbonate 8.4% 1 mL/kg up to 100 mL (1 mmol/kg up to 100 mmol) intravenously, as an initial dose
FOLLOWED BY
sodium bicarbonate 25 mmol/hour by intravenous infusion.
- Add 150 mL of sodium bicarbonate 8.4% to 850 mL glucose 5%, infuse at a rate of 166 mL/hour
Glucose
Intubate and hyperventilate - acidosis on induction is fatal - bag through apnoea
Dialysis - ARF, Acidosis, Toxic, Level >4 despite treatment
Endpoints: Urine pH >7.5