salicylates and Emergencies

We present a 19-month-old boy with a history of asthma who presented to the pediatric emergency department with noisy breathing and tachypnea partially responsive to albuterol. He was discharged to routine care at home. His parents brought him back the next day for persistent respiratory distress despite routine home albuterol. A check of electrolytes showed a low bicarbonate level.

Topics: Acid-Base Equilibrium; Albuterol; Alkalosis, Respiratory; Aspirin; Asthma; Bicarbonates; Bites, Human; Child Abuse; Chlorides; Developmental Disabilities; Emergencies; Humans; Hyperventilation; Infant; Male; Poisoning; Recurrence; Salicylates

Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK.. A retrospective case note study from 1 February 2001 to 31 January 2002 was undertaken at the emergency department of St. Thomas' Hospital, London. Records were reviewed and information on demographic data, history, details of salicylate overdose, and documentation of clinical features of salicylate toxicity recorded.. In total, 722 patient episodes were identified, of which 596 case notes were available and appropriate for inclusion in this study. Plasma salicylate concentrations (range 15-428 mg/l) were detectable in 50 patients (three notes not available), of whom 38 had given a positive history. The history of salicylate poisoning had a sensitivity of 81% (95% confidence interval (CI) 67 to 91%) and the predictive value of a negative history of salicylate ingestion in not detecting salicylate concentrations was 98% (95% CI 97 to 99%). Insufficient information on clinical features of salicylate toxicity was recorded in 569 patients (including 35 patients who had a history of salicylate ingestion).. History of salicylate ingestion has a high sensitivity and negative predictive value with respect to the detection of plasma salicylate concentrations. However, current practice indicates that insufficient information is obtained from patients about the clinical features of toxicity. Routine measurement of plasma salicylate concentrations is not required unless there is (a) a positive history of ingestion of salicylates or (b) a reduced level of consciousness or other reason limiting the validity of the history obtained, together with clinical features consistent with salicylate poisoning.

Topics: Consciousness; Emergencies; Female; Humans; Male; Predictive Value of Tests; Retrospective Studies; Salicylates

Topics: Drug Overdose; Emergencies; Female; Humans; Middle Aged; Salicylates; Salicylic Acid; Treatment Refusal

A spectrum of quantitative and qualitative methods was adapted to the RA-1000/RA-XT selective analyser for the purpose of excluding or detecting common types of intoxication in the emergency laboratory of our primary care community hospital. Ethanol and salicylates (measured photometrically) and acetaminophen (measured immunologically by EMIT tox) were quantitatively analysed in serum. immunological group tests (EMIT tox) for barbiturates, benzodiazepines, tricyclic antidepressants and related compounds were used for qualitative analysis. Well established clinical chemical methods (aspartarte aminotransferase, alanine aminotransferase, creatine kinase, pseudocholinesterase, glucose and lactate) were applied to the serum samples using the same selective analyser. Within and between run precision, accuracy, recovery and detection ranges (linearity) fulfilled the recommendations of forefield toxicological analysis for all methods. Ethanol (g/l), measured photometrically with the RA-1000 analyser, agreed with the reference method (headspace gas-chromatography) with a correlation coefficient greater than 0.99 (y = 0.06 + 0.98x). Acetaminophen and salicylates showed correlation coefficients greater than 0.94 and greater than 0.99, when compared with manual colorimetric procedures (acetaminophen (mg/l): y = -3.22 + 0.896x; salicylates (mg/l): y = -2.1 + 1x). Qualitative group tests for barbiturates, benzodiazepines and tricyclic antidepressants measured with the RA-1000 analyser were in good agreement with the EMIT single test procedure. The ranges of the quantitative methods allowed quantification of analytes from therapeutic (non-toxic) to very high levels in undiluted samples (ethanol 0.05 up to 4 g/l; salicylates 32 up to 1200 mg/l and acetaminophen 1.9 up to 200 mg/l). The low detection limits of the qualitative tests allowed the recognition of compounds in plasma that were present in low concentrations and/or displayed only minor reactivity with the antibodies provided by the EMIT tox test kits. As a consequence, decision limits for all three group tests in serum were lowered to near the detection limit: (table: see text) For quantitative tests the lower limits of quantification were: (table: see text) The working reagents were stable for at least 14 days at 4-8 degrees C. Calibration curves were stable over the expiration period of reconstituted original reagents (6-12 weeks), also when working reagents were prepared in aliquots from stored reconstituted

Topics: Acetaminophen; Alcoholic Intoxication; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Autoanalysis; Barbiturates; Benzodiazepines; Blood Chemical Analysis; Emergencies; Evaluation Studies as Topic; Humans; Poisoning; Salicylates; Sensitivity and Specificity; Toxicology

Acute salicylate poisoning with enteric-coated aspirin may result from accidental ingestion, a suicide attempt, or a complication of long-term therapy. Because absorption of enteric-coated aspirin is delayed, use of the Done nomogram to determine toxicity may lead to underestimating the severity of the poisoning. Treatment options include induction of emesis or diuresis, gastric lavage, administration of activated charcoal, and surgery.

Topics: Adolescent; Drug Overdose; Emergencies; Female; Humans; Salicylates; Tablets, Enteric-Coated; Time Factors

Data were collected on 176 consecutive cases of drug overdose evaluated in an emergency department. Quantitative serum toxic screening (TS) was performed for 164 (93%) of these patients; positive results were noted for 133 patients (81%). Six classes of drugs (ethanol, benzodiazepines, salicylates, acetaminophen, barbiturates, and tricyclic antidepressants) were responsible for nearly 70% of all drug detections and were associated with 80% of all admissions in this patient sample. Only two patients (1%) had drug-specific treatment initiated because of TS results. In 12 patients (7%), TS confirmed substances for which specific treatments had been initiated on clinical grounds. Four patients (2%) had drug-specific treatment discontinued because of TS results. Thirty-two patients (19%) were admitted to a medical service; however, only seven patients (4%) were admitted primarily because of TS results. All other patients were admitted because of clinical abnormalities that required inpatient care. It is concluded that only a few drugs are responsible for most drug overdoses. Moreover, TS results rarely change the treatment or disposition of overdose patients; these decisions are typically based on clinical parameters.

Topics: Acetaminophen; Alcoholic Intoxication; Antidepressive Agents, Tricyclic; Barbiturates; Blood Chemical Analysis; Diazepam; Drug Overdose; Emergencies; Humans; Retrospective Studies; Salicylates

This salicylate-specific assay can be adapted for use with most discrete analyzers, for rapid emergency or routine testing with small serum or plasma sample volumes and a single calibration. The basis of this method is as follows: salicylate monooxygenase (EC 1.14.13.1) converts salicylate to catechol in the presence of NADH; the catechol then reacts with 4-aminophenazone under alkaline conditions, catalyzed by manganese ions, to produce a red dye. Incorporation of an NADH-regenerating system, involving glucose and glucose dehydrogenase, into the enzyme reagent ensures that the working reagent is stable for more than two weeks. The standard curve is linear over the drug concentration range 0 to 5 mmol/L. The CV was less than 4% over 20 days. Results correlated well with those by the Trinder colorimetric method and an HPLC method. We saw no interference by any of 80 drugs we tested at therapeutic concentrations or by endogenous compounds in serum.

Topics: Autoanalysis; Buffers; Catechols; Chromatography, High Pressure Liquid; Colorimetry; Emergencies; Humans; Hydrogen-Ion Concentration; Indicators and Reagents; Mixed Function Oxygenases; NAD; Poisoning; Salicylates; Surface-Active Agents

Acute salicylate poisoning may result in death. A review of seven fatal cases of salicylate poisoning in Ontario in 1984 showed that the average duration of hospitalization before death was 18.1 hours. Factors that contributed to death included failure to administer activated charcoal and sodium bicarbonate, to appreciate the need for hemodialysis and to consult with experts in toxicology.

Topics: Adult; Emergencies; Fluid Therapy; Humans; Ontario; Prognosis; Renal Dialysis; Retrospective Studies; Salicylates

Between February and May 1984, we conducted a pilot study to examine the methods for a larger study of a previously reported relation between Reye's syndrome and medications. Thirty patients with Reye's syndrome, whose diagnosis was confirmed by an expert panel, and 145 controls were matched for age, race (black or not black), and antecedent illness (respiratory infection, chickenpox, or diarrhea) and selected from the same hospital, emergency room, or school, or identified by random digit dialing. Significantly more cases (93 per cent, 28 of 30) than members of each of the four control groups or all controls combined (46 per cent, 66 of 145) had received salicylates during matched antecedent illnesses (odds ratio of all 30 cases vs. all controls = 16.1; lower 95 per cent confidence limit = 4.6). The prevalence and mean severity score of signs, symptoms, and selected events during the antecedent illness tended to be lower among cases than controls. Thus, differences in the severity of this illness between cases and controls did not explain differences in medication exposures. This pilot study suggests an association between Reye's syndrome and the use of salicylates during an antecedent illness.

Topics: Acetaminophen; Adolescent; Chickenpox; Child; Child, Preschool; Emergencies; Female; Humans; Infant; Male; Pilot Projects; Respiratory Tract Diseases; Reye Syndrome; Salicylates; Therapeutic Equivalency; Time Factors

Several variables must be considered in the treatment of a poisoned child, including the particular substance, the individual child, and the child's home environment. General principles of treatment are described, and the management of particular substances, including household cleaning products, petroleum distillate hydrocarbons, and salicylates, is detailed. The family should not leave the emergency room without instruction on prevention of poisoning.

Topics: Alcoholic Intoxication; Antidotes; Carbon Monoxide Poisoning; Cathartics; Child; Child, Preschool; Emergencies; Histamine H1 Antagonists; Household Products; Humans; Infant; Iron; Petroleum; Plant Poisoning; Poisoning; Salicylates; Sympathomimetics; Time Factors

All patients in stupor or coma should undergo blood chemistry studies, including blood gases. The anion gap and serum osmolality must be calculated in all patients. An indwelling catheter to monitor urine content and volume is essential. Electrocardiogram monitoring is indicated in all significant metabolic acidosis, especially for evaluation of intracellular potassium effect and arrhythmias. Repeated arterial monitoring of blood gases and electrolytes is essential with the use of flow sheets. Sodium lactate and Ringer's solution should never be given in an emergency care area. Large doses of insulin (100+ units intravenously) are not necessary or indicated in diabetic ketoacidosis and may be contraindicated and dangerous especially in HHNKC. Intravenous or intramuscular regular insulin after urine tests for glucose and ketones alone should not be given. Urine dilution of serum ketones is useless, and serum dilution may be grossly misleading and contraindicated: arterial studies are much more reliable.

Topics: Acidosis; Blood Glucose; Diabetic Ketoacidosis; Diagnosis, Differential; Electrolytes; Emergencies; Ethylene Glycols; Humans; Hypoglycemia; Lactates; Metabolic Diseases; Methanol; Salicylates; Uremia

An analysis of 37 patients over the age of 65 years who underwent emergency surgery for complications of peptic ulcer is presented. A major predisposing factor to these complications was the use of ulcerogenic drugs that were prescribed for chronic musculo-skeletal ailments. The overall mortality was 23.5%, and was mainly related to pre-existing cardio-pulmonary disease.

Topics: Aged; Emergencies; Heart Failure; Humans; Indomethacin; Lung Diseases, Obstructive; Peptic Ulcer; Salicylates; Steroids

From 3,548 drug overdose or abuse cases presenting at 21 Metropolitan Toronto hospitals' Emergency departments, data concerning demographic and medical characteristics, investigative and management procedures, drug analysis services, and disposition of patients were collected. Of the 3,548 cases, 2,723 (77%) were acute overdose and 816 (23%) were drug abuse. Drug overdose was more common than drug abuse for both sexes, but was more characteristic of females. The drugs most frequently alleged ingested were benzodiazepines (34%), ethanol (32%), salicylates (16%), and barbiturates (14%). The frequency with which particular classes of drugs are alleged in overdose corresponds closely to the frequency of prescribing these drugs in Ontario.

Topics: Adult; Alcoholic Intoxication; Barbiturates; Benzodiazepines; Emergencies; Female; Humans; Male; Middle Aged; Ontario; Salicylates; Substance-Related Disorders; Suicide, Attempted

The various stages in the diagnostic process are discussed with particular reference to rheumatology. Consideration is given to recent "early" and "preclinical" diagnosis concepts, and these are applied to the aircrew category. The main "rheumatological emergencies" are listed and described for the purposes of that "specialised" prevention constantly needed to a greater extent, not only in the complex, demanding activity of aircrew, but also in the wider "world of labour", as currently conceived.

Topics: Aerospace Medicine; Collagen Diseases; Emergencies; Gout; Humans; Hydrarthrosis; Salicylates; Sciatica

Topics: Acute Disease; Adult; Anticoagulants; Cortisone; Diagnostic Errors; Drug Synergism; Emergencies; Esophageal and Gastric Varices; Esophagitis; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Peptic Ulcer Hemorrhage; Retrospective Studies; Salicylates

Topics: Acetaminophen; Antidepressive Agents; Barbiturates; Benzazepines; Chloral Hydrate; Chromatography, Thin Layer; Colorimetry; Desipramine; Emergencies; Hallucinogens; Humans; Hydrogen-Ion Concentration; Imipramine; Indicators and Reagents; Narcotics; Pharmaceutical Preparations; Phenothiazines; Poisoning; Psychoses, Substance-Induced; Salicylates; Solvents