salicylates and Hepatic-Encephalopathy

Topics: Administration, Oral; Barbiturates; Charcoal; Clinical Trials as Topic; Hepatic Encephalopathy; Humans; Kidney Failure, Chronic; Poisoning; Renal Dialysis; Salicylates

A patient who developed chronic salicylism associated with salicylate therapy for treatment of juvenile rheumatoid arthritis is described, and the clinical presentation and treatment of chronic salicylism are reviewed. A 5 1/2-year-old boy was receiving aspirin 150/mg/kg/day for treatment of juvenile rheumatoid arthritis. While on salicylate therapy, the patient developed tachypnea and became increasingly hyperthermic, lethargic, and disoriented. The patient developed a maculopapular rash, weakness, and a decreased level of consciousness during the 11 days before admission to the hospital. Physical examination and laboratory determinations revealed that the patient had hypoprothrombinemia, hypoglycemia, and severe hepatic encephalopathy secondary to long-term salicylate toxicity. The patient was treated for hypoglycemia, electrolyte imbalances, thrombocytopenia, and anemia and was discharged after 24 days. Diagnosing chronic salicylism with hepatic dysfunction was difficult because the symptoms are similar to those of stage I to stage II Reye's syndrome. Liver enzymes, including aspartate aminotransferase (also called SGOT), alanine aminotransferase (also called SGPT), alkaline phosphatase, and lactate dehydrogenase, may be elevated in juvenile arthritis patients with hepatic dysfunction. Liver dysfunction usually improves when salicylate therapy is discontinued. Supportive therapy should always be used in symptomatic patients. Children on long-term, high-dose salicylate therapy should be monitored closely, and baseline liver function tests should be performed. The clinical effectiveness of administering sodium bicarbonate in attempts to alkalinize urine and increase salicylate elimination is controversial. In patients with juvenile rheumatoid arthritis who develop chronic salicylism, careful analysis of the patient's medication history, laboratory values, and clinical presentation are necessary to rule out Reye's syndrome.

Topics: Arthritis, Juvenile; Child, Preschool; Diagnosis, Differential; Hepatic Encephalopathy; Humans; Liver Function Tests; Male; Reye Syndrome; Salicylates

High-dose, long-term aspirin therapy easily overloads the patient's individual capacity to metabolize salicylates and may lead to complex metabolic disturbances including fulminant hepatic failure, hyperammonemia and toxic metabolic encephalopathy. In the two cases presented there was a severe outbreak of hepatotoxic encephalopathy despite the fact that the dosage of salicylates did not exceed that generally recommended for children with rheumatic diseases. The justification of high-dose salicylate therapy is discussed, taking into account the fact that children with juvenile rheumatoid arthritis and allied conditions may have increased susceptibility to liver damage from drugs. EEG abnormalities in these two cases corresponded to those described in other metabolic encephalopathies including Reye's syndrome. The quality of the EEG changes gives prognostic signs, but is of restricted value in establishing the etiology without the anamnestic data of salicylate ingestion. Active therapeutic measures including exchange transfusions are needed to prevent irreversible metabolic and pressure changes in the brain.

Topics: Adolescent; Ammonia; Chemical and Drug Induced Liver Injury; Child; Electroencephalography; Female; Hepatic Encephalopathy; Humans; Joint Diseases; Liver; Male; Salicylates

Toxic ingestions of acetaminophen and aspirin are clearly distinct in clinical presentations and in implications for laboratory medicine. In acetaminophen ingestion, the serum drug level is the single most important factor in the decision for or against therapy. In aspirin ingestion, the serum drug level is useful at its extremes--when so low as to indicate no need for therapy, and when so high as to indicate the need for dialysis. In the majority of infants and children with clinically significant salicylism, the serum drug level is in an intermediate range. For the management of these patients, the absolute level of salicylate in blood has much less significance than the laboratory assessment of the effects of salicylate on intermediary metabolism, acid-base status, and electrolyte and water balance.

Topics: Acetaminophen; Acetylcysteine; Acid-Base Imbalance; Aspirin; Child, Preschool; Female; Hepatic Encephalopathy; Humans; Infant; Liver; Male; Poisoning; Salicylates; Time Factors

Topics: Antacids; Gastrointestinal Diseases; Hepatic Encephalopathy; Immunoglobulins; Parasympatholytics; Salicylates; Triglycerides

Topics: Acidosis; Aged; Blood Urea Nitrogen; Bradycardia; Catheterization; Female; Heart Failure; Hepatic Encephalopathy; Humans; Hyperglycemia; Kidney Failure, Chronic; Male; Methanol; Middle Aged; Peritoneal Dialysis; Pyelonephritis; Salicylates