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administered because it may enhance postabsorptive elimination of salicylates (through GI dialysis) Healthcare providers should be wary of sedating or mechanically ventilating aspirin-poisoned patients, as depressing the spontaneous ventilation rate may worsen acidosis and lead to more severe aspirin-induced neurotoxicity Specific therapeutic goals in salicylate intoxication include correction of fluid and electrolyte disturbances and the enhancement of salicylate excretion Fluid therapy is aimed at restoring hydration and electrolyte balance, preventing distribution of salicylate to the brain, and promoting renal salicylate excretion Aggressive restoration of intravascular volume is advisable; however, fluids should be given prudently to prevent precipitation of pulmonary edema, particularly in patients with severe intoxication Hypokalemia promotes absorption of salicylates and impairs alkalinization required to enhance elimination, so correct hypokalemia aggressively For patients with symptomatic salicylate intoxication, urine alkalinization should be combined with fluid resuscitation The administration of sodium bicarbonate, by increasing urinary pH, ionizes filtered aspirin, increasing tubular secretion and inhibiting its tubular reabsorption (ion trapping) The initial fluid is, therefore, designed to replace both sodium and bicarbonate losses as well as promote urine alkalinization It should contain 5% dextrose with 100 to 150 mEq/L of sodium bicarbonate The goal should be a blood pH of 7.45 to 7.5 and a urine pH of Because hypokalemia impairs the ability of the kidney to create alkaline urine and is exacerbated by administration of sodium bicarbonate, potassium must be added to IV fluids Forced diuresis should not be used as it does not enhance salicylate excretion more than the clearance accomplished by alkalinization alone Therefore, fluids are given as needed to restore normal hydration and to produce to mL/kg/hr of urine Calcium homeostasis should also be monitored during therapy with exogenous bicarbonate Urine alkalinization should be continued until salicylate concentration falls below 30 mg/dL and symptoms resolve As long as there are no contraindications, a second dose of charcoal should be considered if salicylate levels are not downtrending as anticipated, if the ingestion was massive, or if there is clinical concern for a pharmacobezoar Salicylate elimination can also be enhanced by hemodialysis or hemoperfusion Although hemoperfusion results in superior clearance, hemodialysis is usually preferred because it permits correction of fluid and electrolyte imbalances and it is more readily available Hemodialysis should be reserved for seriously ill patients Hemodialysis might be considered for patients with serum salicylate
Ngày đăng: 22/10/2022, 12:56
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