salicylates and Hyperventilation

A poor therapeutic response may be explained by incomplete or erroneous diagnostic assessment, by failure to employ optimal drug doses and combinations, or by inadequate attention to the non-pharmacologic aspects of management. Poor compliance and counterproductive patient attitudes may need to be addressed. These problems and the approach to asthma concomitant with other diseases are discussed.

Topics: Asthma; Diabetes Complications; Diagnosis, Differential; Dyspnea, Paroxysmal; Female; Gastroesophageal Reflux; Heart Diseases; Humans; Hyperventilation; Occupational Diseases; Patient Compliance; Physician-Patient Relations; Pregnancy; Pregnancy Complications; Respiratory Tract Diseases; Respiratory Tract Infections; Salicylates; Sleep Wake Disorders; Surgical Procedures, Operative; Sympathomimetics; Theophylline; Thyroid Diseases

Topics: Acidosis, Respiratory; Acute Disease; Age Factors; Animals; Central Nervous System; Hyperventilation; Oxidative Phosphorylation; Poisoning; Rabbits; Rats; Salicylates

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

1. The extent to which peripheral arterial chemoreceptors are involved in the respiratory stimulant action of salicylates has been investigated in rats. 2. Injection of sodium salicylate (200 mg kg-1, single dose i.v.) caused a rapid transient hyperventilation that was not obtained when the carotid chemoreceptors were denervated by section of the carotid sinus nerves. A delayed (10 min) increase in respiration occurred regardless of whether or not the carotid nerves were sectioned. 3. Intravenous infusions of sodium salicylate (0.5 or 4 mg kg-1 min-1) caused hyperventilation in barbiturate-anaesthetized rats. The threshold dose for respiratory stimulation was significantly lower when the carotid sinus nerves were intact than when they were bilaterally sectioned, and the same pattern was observed following intravenous injections of sodium salicylate (cumulative doses) in anaesthetized and conscious rats. 4. Bilateral sectioning of the vagosympathetic nerve trunks did not significantly affect hyperventilation evoked by salicylate, suggesting that this response does not involve actions of salicylate on sensory receptors innervated by these nerves. 5. Administration of salicylate close-arterial to a carotid body, by local perfusion or cross-perfusion of a carotid sinus, led to an increase in respiration when the ipsilateral carotid nerve was intact, but not when it was sectioned. 6. Neuropharmacological studies on anaesthetized rats showed that chemosensory discharge, recorded from a sectioned carotid nerve, increased in response to salicylate injections with a similar dose-response pattern to the hyperventilation. Salicylate had no effect on baroreceptor discharge. 7. We conclude from our experiments that arterial chemoreceptors do contribute to salicylate-induced hyperventilation, and are almost exclusively responsible for the initial phase of the response in rats. Later increases in breathing are independent of reflexes from arterial chemoreceptors and result from actions at other sites, including the CNS. The therapeutic implications of our results are discussed.

Topics: Animals; Aspirin; Blood Pressure; Chemoreceptor Cells; Cyanides; Hyperventilation; Injections, Intravenous; Male; Neurons; Oxygen; Perfusion; Rats; Rats, Inbred Strains; Respiration; Respiratory Function Tests; Salicylates

Topics: Humans; Hyperventilation; Salicylates

Hyperventilation and hyperpyrexia occur simultaneously during acute salicylate intoxication. The present experiments were designed to investigate the stimulatory effect of increased body temperature on respiration in this pathological state. Acute salicylate intoxication was produced in mongrel dogs by intravenous infusion of 200 mg sodium salicylate/kg body weight, and the effect of body temperature on salicylate-induced hyperventilation was studied by comparing the respiration of hyperthermic animals with the respiration of animals maintained normothermic during acute salicylate intoxication by bathing them in cold water. The minute volume of ventilation increased greatly over control levels in both normothermic and hyperthermic animals, but this increment was much larger in hyperthermic animals. The increase in ventilation of normothermic animals can be explained as a rise in alveolar ventilation which results in hypocapnia despite large increases in carbon dioxide production and oxygen consumption during acute salicylate intoxication. The further augmentation of ventilation in hyperthermic animals can be explained as a rise in deadspace ventilation in response to increased body temperature during acute salicylate intoxication.

Topics: Animals; Body Temperature; Carbon Dioxide; Dogs; Female; Hyperventilation; Male; Oxygen Consumption; Respiration; Salicylates

To evaluate the relative severity of acute vs chronic salicylate poisoning in children, 112 cases (65 acute and 47 chronic) of salicylate poisoning (salicylate concentration greater than or equal to 20 mg/100 ml) admitted to The Children's Hospital Medical Center in Boston and Primary Children's Medical Center in Salt Lake City between the years 1967 and 1978 were analyzed. Hyperventilation (P less than .01), dehydration (P less than .001), and severe central nervous system manifestations (P less than .001) occurred more frequently in the chronic group and remained more frequent (P less than .01) when patients having disease states capable of producing these signs and symptoms were removed from statistical analysis. At three separate salicylate concentration ranges (20 to 39, 40 to 59, and greater than or equal to 60 mg/100 ml) hyperventilation, dehydration, and severe CNS manifestations tended to occur with greater frequency in the chronic group. When severity of salicylate poisoning was categorized based on a combination of signs and symptoms, mild cases occurred more frequently in the chronic group. Finally, systemic acidosis (pH less than 7.32) was found more frequently in the chronic group (P less than .01), more frequently in patients with severe manifestations than in those with mild manifestations, and in patients with dehydration (P less than .01) and severe CNS manifestations (P less than .05). Based on the variables evaluated, chronic salicylism produces a greater morbidity than does acute salicylate poisoning in the pediatric patient.

Topics: Acidosis; Acute Disease; Adolescent; Central Nervous System Diseases; Child; Child, Preschool; Chronic Disease; Dehydration; Female; Humans; Hyperventilation; Infant; Male; Nausea; Salicylates; Vomiting

Topics: Acid-Base Equilibrium; Acidosis; Acidosis, Respiratory; Alkalosis; Alkalosis, Respiratory; Animals; Bicarbonates; Brain; Calcium; Cerebrospinal Fluid; Humans; Hydrocephalus; Hydrogen-Ion Concentration; Hyperventilation; Intracranial Pressure; Magnesium; Potassium; Radioisotopes; 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: Acidosis, Respiratory; Animals; Aspirin; Blood-Brain Barrier; Brain; Carbon Dioxide; Dogs; Humans; Hydrogen-Ion Concentration; Hyperventilation; Infant; Male; Oxygen; Respiratory Center; Salicylates

Topics: Acid-Base Equilibrium; Adult; Anesthesia, General; Humans; Hyperventilation; Male; Poisoning; Salicylates; Wounds and Injuries

Topics: Animals; Carbon Dioxide; Carbon Isotopes; Chlorine; Dogs; Hydrogen; Hydrogen-Ion Concentration; Hyperventilation; Lactates; Male; Muscles; Pyruvates; Radioisotopes; Salicylates; Tritium

Topics: Administration, Intravenous; Humans; Hyperventilation; Pharmaceutical Preparations; Respiration; Salicylates; Sodium Salicylate