salicylates and Coma

Poisoning with salicylic acid and its derivatives is a quite common event, leading to possibly life-threatening complications. A case of fatal intoxication of a sixty-year old patient with acetylsalicylic acid is described and the therapeutic options are discussed. In acute poisoning it is mandatory to initiate simple and effective measures first. This gives time for discussing and planning the more laborious procedures. The initial treatment of salicylate poisoning is based on the prevention of further absorption by a sufficiently large quantity of orally administered activated charcoal (approximately 1 g/kg b.w.). Given repeatedly, activated charcoal may enhance non-renal clearance of salicylates. Intravenously administered sodium bicarbonate counteracts the metabolic acidosis. Moreover, bicarbonate therapy limits tissue distribution of the drug and enhances its renal excretion. The availability of glycine for salicylic acid metabolism may be limited in poisoning because glycine has been used for forming the conjugation product salicyluric acid. Glycine may be administered orally to overcome this bottleneck. Gastric lavage has been proven to be of limited efficacy. This efficacy is further diminished if gastric lavage is performed late after drug ingestion. When it is performed, however, activated charcoal should be administered before and after gastric lavage. Whenever the more simple treatment options fail, hemodialysis or hemoperfusion should be additionally considered since these procedures are effective in removing salicylates from the body.

Topics: Aspirin; Charcoal; Coma; Fatal Outcome; Female; Fever; Gastric Lavage; Glycine; Hemoperfusion; Humans; Middle Aged; Poisoning; Renal Dialysis; Salicylates; Sodium Bicarbonate

The present review catalogues 1418 reported cases of drug-induced hypoglycemia. The main findings are that sulfonylureas (especially chlorpropamide and glyburide), either alone or with a second hypoglycemic or potentiating agent, still account for 63% of all cases; that alcohol, propranolol, and salicylate, either singly or with another hypoglycemic drug, are the next most frequent offenders (19% of the total); and that one older drug (quinine) and three new ones (pentamidine, ritodrine, and disopyramide) have caused an additional 7% of all episodes of severe hypoglycemia. The clinical factors that set the stage for drug-induced hypoglycemia are still restricted food intake, age, hepatic disease, and renal disease, both individually and even more so in combination. Drug-induced hypoglycemia continues to be so common that virtually every unconscious patient should be considered hypoglycemic until immediate estimation of the blood sugar level rules it in or out. If ruled in, the clinician should promptly start 10% intravenous glucose and plan to maintain it uninterruptedly for 1 or more days, with added glucagon, hydrocortisone, and diazoxide administration if necessary, until sustained hyperglycemia guarantees that all drug effects have worn off.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Coma; Humans; Hypoglycemia; Hypoglycemic Agents; Infant; Infant, Newborn; Middle Aged; Salicylates; Sulfonylurea Compounds

Topics: Amphetamine; Amphetamines; Autoanalysis; Barbiturates; Chemical Phenomena; Chemistry; Chromatography, Thin Layer; Coma; Electron Spin Resonance Spectroscopy; Humans; Hydrogen-Ion Concentration; Imipramine; Lysergic Acid Diethylamide; Magnetic Resonance Spectroscopy; Mass Spectrometry; Meprobamate; Opium; Pharmaceutical Preparations; Salicylates; Spectrometry, Fluorescence; Spectrophotometry, Ultraviolet; Substance-Related Disorders; Tranquilizing Agents

Topics: Acetohexamide; Adolescent; Adult; Aminobenzoates; Child; Child, Preschool; Chlorpropamide; Coma; Edetic Acid; Ethanol; Female; Humans; Hypoglycemia; Hypoglycemic Agents; Infant; Infant, Newborn; Insulin; Male; Manganese; Middle Aged; Nutritional Physiological Phenomena; Oxytetracycline; Propranolol; Salicylates; Sulfonylurea Compounds; Tolbutamide

Topics: Acetaminophen; Acid-Base Equilibrium; Acidosis; Acute Kidney Injury; Alkalosis, Respiratory; Aspirin; Calcium; Coma; Dehydration; Fever; Gastric Lavage; Hemorrhage; Humans; Hydrogen-Ion Concentration; Infusions, Parenteral; Poisoning; Salicylamides; Salicylates; Seizures; Tetany; Vomiting

Factor analysis of admission data from 209 Reye's syndrome patients yielded three factors. Factor 1 was associated with encephalopathy, blood ammonia, creatinine kinase (CK), uric acid and, to a lesser extent, bilirubin. This factor was linked to the encephalopathy and hypermetabolic changes in muscle, possibly prostaglandin-mediated proteolysis. Factor 2 was associated with serum alanine aminotransferase (AlaAT) and aspartate aminotransferase (AspAT), and was identified as a hepatic lesion component. These factors correspond to two etiologic components of Reye's syndrome. Salicylate was only weakly associated with neuropathic and hypercatabolic indicators and not at all associated with the hepatic damage indicators.

Topics: Brain Diseases; Child; Child, Preschool; Coma; Humans; Liver Diseases; Respiratory Tract Infections; Reye Syndrome; Salicylates; Statistics as Topic

A 3-year-old White child was admitted to the critical care unit in a coma after a generalized convulsion. Codeine and salicylic acid were present in his plasma. The possible aetiology and management are discussed.

Topics: Child, Preschool; Codeine; Coma; Humans; Male; Salicylates; Seizures

It was traditionally assumed that ethanol, as part of an intentional drug overdose, will increase morbidity and mortality. The authors prospectively studied the effect of ethanol on the outcome of intentional drug overdose in 468 adults, 196 of whom required hospital admission. Ethanol was detected in significantly fewer patients who required admission. Ethanol ingestion was not related to coma, impaired vital signs or mortality. Indeed, the duration of coma was significantly shorter in patients in whom ethanol was detected, but this group had a lesser incidence of multiple drug and nonbarbiturate hypnotic ingestion and a greater incidence of chronic ethanol use. Thus, it seems that ethanol is not associated with a worse clinical course if the drug overdose patient reaches medical care before an irreversible event.

Topics: Adolescent; Adult; Aged; Antidepressive Agents, Tricyclic; Barbiturates; Benzodiazepines; Coma; Diazepam; Drug Interactions; Ethanol; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nordazepam; Phenothiazines; Poisoning; Salicylates; Suicide, Attempted

Topics: Aspirin; Brain Edema; Child, Preschool; Coma; Female; Humans; Infant; Mannitol; Salicylates; Time Factors

Topics: Adult; Barbiturates; Blood Pressure; Body Temperature; Charcoal; Coma; Female; Hemoperfusion; Humans; Male; Middle Aged; Salicylates; Salicylic Acid; Time Factors

Topics: Adult; Amitriptyline; Antidepressive Agents; Athetosis; Child, Preschool; Chorea; Coma; Female; Humans; Imipramine; Injections, Intravenous; Male; Myoclonus; Physostigmine; Salicylates

Topics: Acid-Base Equilibrium; Acidosis; Cardiovascular Diseases; Coma; Fever; Gastric Lavage; Gastrointestinal Diseases; Humans; Hydrogen-Ion Concentration; Hyperventilation; Neurologic Manifestations; Oxygen Consumption; Peritoneal Dialysis; Renal Dialysis; Salicylates; Water-Electrolyte Balance

Topics: Amitriptyline; Barbiturates; Carbon Monoxide Poisoning; Coma; Electroencephalography; Fungi; Humans; Imipramine; Insecticides; Isoniazid; Poisoning; Resuscitation; Salicylates; Time Factors; Trichloroethylene

Topics: Adult; Alcoholic Intoxication; Barbiturates; Bromides; Coma; Diagnosis, Differential; Diazepam; Erythema; Female; Humans; Male; Salicylates; Skin Manifestations; Substance-Related Disorders

Topics: Acute Disease; Adult; Barbiturates; Charcoal; Coma; Emergency Service, Hospital; First Aid; Humans; Intensive Care Units; Poisoning; Psychology; Respiratory Function Tests; Salicylates; Shock; Vomiting

Topics: Adolescent; Adult; Age Factors; Aged; Antidepressive Agents; Barbiturates; Child; Coma; Diuresis; Female; Glutethimide; Humans; Hypnotics and Sedatives; Male; Middle Aged; Peritoneal Dialysis; Poisoning; Renal Dialysis; Salicylates; Sex Factors; Statistics as Topic; Time Factors; Tranquilizing Agents

Topics: Acidosis; Aged; Alcoholic Intoxication; Alkalosis; Alkalosis, Respiratory; Arrhythmias, Cardiac; Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Encephalitis, Arbovirus; Humans; Male; Myocardial Infarction; Poisoning; Salicylates; Stomach Neoplasms; Sweating

Topics: Adolescent; Adult; Aged; Antidotes; Barbiturates; Carbon Monoxide Poisoning; Child; Coma; Diuretics; Female; Humans; Male; Middle Aged; Respiration, Artificial; Salicylates; Tranquilizing Agents

Topics: Aspirin; Brain Diseases; Carbohydrate Metabolism; Coma; Fatty Liver; Heart Diseases; Humans; Kidney Diseases; Salicylates; Toxicology; Viscera

Topics: Aspirin; Blood Chemical Analysis; Body Fluids; Coma; Indicators and Reagents; Salicylates; Toxicology; Urine

Topics: Acute Kidney Injury; Aspirin; Blood Chemical Analysis; Bronchopneumonia; Coma; Diagnosis, Differential; Diuresis; Gastric Lavage; Heart Arrest; Heart Failure; Humans; Infusions, Parenteral; Kidney; Kidneys, Artificial; Phenacetin; Poisoning; Pulmonary Edema; Renal Insufficiency; Salicylates; Statistics as Topic; Toxicology

Topics: Aspirin; Child; Coma; Diabetic Coma; Diagnosis; Diagnosis, Differential; Humans; Hyperglycemia; Infant; Parent-Child Relations; Parents; Poisoning; Salicylates; Toxicology; Urine

Topics: Coma; Gastric Juice; Salicylates