Acetazolamide and Sodium Bicarbonate in Treatment of Salicylate Poisoning in Adults

Morgan, A. G.; Polak, A.

doi:10.1136/bmj.1.5635.16

Cited by 23 publications

(12 citation statements)

References 10 publications

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“…These levels are comparable to concentrations reported in the literature in cases of severe human intoxication (5,9,24 ,--------I nously and hyperventilation occurred, the administra-_-----tion of 5% CO in the inspired gas did not prevent enhancement of potassium excretion.…”

Section: Discussionsupporting

confidence: 74%

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Direct Effects of Salicylate on Renal Function in the Dog

Quintanilla¹,

Kessler²

1973

J. Clin. Invest.

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Section: Discussionsupporting

confidence: 74%

“…Reports of other alterations in composition of extracellular fluid are conflicting. The concentration of potassium in plasma has been reported as increased (2), decreased (3), or unchanged (4,5). Hyperglycemia (6) as well as hypoglycemia (7) is described.…”

mentioning

confidence: 99%

Direct Effects of Salicylate on Renal Function in the Dog

Quintanilla¹,

Kessler²

1973

J. Clin. Invest.

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“…The evidence in this paper suggests that an increase in the volume of alkaline urine from 6.8 to 9.1 litres exerts no effect upon the rate of salicylate excretion. Morgan & Polak (1969) obtained rates of salicylate removal similar to those described in this paper using only 4 litres of fluid, and in some individual cases, less than 2 litres. The salicylate clearance obtained in our patients averages 11 mg/min, whilst Morgan & Polak quoted 13 mg/min and Lawson et al 10.0 mg/min.…”

Section: Discussionsupporting

confidence: 74%

“…Moreover, in all patients the serum potassium returned to normal within 24 hr. Administration of potassium during treatment was undertaken by Morgan & Polak (1969) but despite this, their net potassium loss was 63 mEq and the fall in serum potassium averaged 1.4 mEq/l. Since these authors used only 4 litres of infusion with added potassium the similarity in the results is striking.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Salicylate Poisoning Using Mannitol and Forced Alkaline Diuresis

et al. 1970

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1.A comparison has been made between alkaline mannitol diuresis and alkaline glucose diuresis in the treatment of salicylate poisoning during an 8 hr period.2. Mannitol gave a higher rate of urine flow, but there was no significant difference in the rate of salicylate excretion.3. Serum levels of sodium, potassium and calcium fell in both groups, mainly during the first 2 hr. The mean fall in serum sodium was greater (21.4 mEq/l compared with 10.0 mEq/l) and that in serum potassium less (0.6 mEq/l compared with 1.5 mEq/l) in patients who received mannitol than in those who did not.4. All serum electrolyte values had returned to normal within 24 hr of the end of the treatment period.5. Acid-base changes occurring during treatment are described. 6. No adverse clinical features were seen in either treatment group. 7. Syrup of ipecacuanha was used to induce emesis. The mean recovery of salicylate in the vomitus was 38% of the apparent total ingested. The variability in recovery (041%) was not related to the delay between ingestion and vomiting.8. It is concluded that mannitol does not increase the excretion of salicylate. It maintains good urinary excretion, thereby increasing the safety of the procedure. It is associated with a smaller fall in serum potassium and permits rapid removal of salicylate for a smaller rise in serum pH than does forced alkaline diuresis alone.

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“…The interplay between these two opposing acid-base pertur bations will depend in part on the dose of salicylate, the age of the patient and the duration of exposure. The plasma concentration of potassium in salicylate intoxi cation has been reported as increased [95], decreased [96] or unchanged [97,98], Salicylate administration to anes thetized dogs [99] results in elevation of plasma potassium and phosphorus levels. In the dog, the renal clearance of potassium is increased following the systemic or renal artery injection of salicylate [99].…”

Section: Rarer Forms Of Organic Acidemiasmentioning

confidence: 99%

Serum Potassium Concentration in Acidemic States

Pérez¹,

Oster²,

Vaamonde³

1981

Nephron

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It has been generally accepted that acidosis results in hyperkalemia because of shifts of potassium from the intracellular to the extracellular compartment. There is ample clinical and experimental evidence, however, to support the conclusion that uncomplicated organic acidemias do not produce hyperkalemia. In acidosis associated with mineral acids (respiratory acidosis, end-stage uremic acidosis, NH₄CI- or CaCl₂-induced acidosis), acidemia per se, results in predictable increases in serum potassium concentration. In acidosis associated with nonmineral organic acids (diabetic and alcoholic acidosis, lactic acidosis, methanol and the less common forms of organic acidemias secondary to methylmalonic and isovaleric acids, and ethylene glycol, paraldehyde and salicylate intoxications), serum potassium concentration usually remains within the normal range in uncomplicated cases. A number of factors, however, may be responsible for hyperkalemia in some of these patients other than the acidemia per se. These include dehydration and renal hypoperfusion, preexisting renal disease, hypercatabolism, diabetes mellitus, hypoaldosteronism, the status of potassium balance, and therapy. The mechanism(s) of this differing effect of mineral and organic acidemias on transmembrane movement of potassium remains undefined. The prevalent hypothesis, however, favors the free penetrance of the organic anion into cells without creating a gradient for the hydrogen ions and, thus, obviating the efflux of intracellular potassium. The importance of the presence of hyperkalemia in clinical states of organic acidemias is obvious. A search for the complicating factors reviewed above should be undertaken since organic acidemias per se, should not be expected to be accompanied by elevations of serum potassium concentration. Moreover, the classical teaching that the absence of hyperkalemia during severe acidosis is indicative of severe potassium deficiency, may not be universally valid in patients with uncomplicated organic acidemias.

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Acetazolamide and Sodium Bicarbonate in Treatment of Salicylate Poisoning in Adults

Cited by 23 publications

References 10 publications

Direct Effects of Salicylate on Renal Function in the Dog

Direct Effects of Salicylate on Renal Function in the Dog

The Treatment of Salicylate Poisoning Using Mannitol and Forced Alkaline Diuresis

Serum Potassium Concentration in Acidemic States

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