Reversal of salicylate-induced euglycemic delirium with dextrose

Kuzak, Nick; Brubacher, Jeffrey R.; Kennedy, James R.

doi:10.1080/15563650701365800

Cited by 3 publications

(2 citation statements)

References 11 publications

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“… 22 As the kidney tries to retain potassium, the urine becomes more acidotic and does not favor urinary excretion of the salicylate. Glucose is important to measure because neuroglycopenia can happen at normal glucose level, 14 , 15 and it is preferable for a toxic patient to be normo- to hyperglycemic.…”

Section: Case Discussionmentioning

confidence: 99%

83-year-old Woman with a Fever and Emesis

Birch

Dubbs

Bontempo

et al. 2018

Clinical Practice and Cases in Emergency Medicine

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Section: Case Discussionmentioning

confidence: 99%

83-year-old Woman with a Fever and Emesis

Birch

Dubbs

Bontempo

et al. 2018

Clinical Practice and Cases in Emergency Medicine

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“…Patients (and providers) may be unaware of hypoglycemia in the absence of objective testing; both the counter-regulatory autonomic response and overt neurological deficit may be absent [233,234]. Additionally, significant neuroglycopenia and hypoglycemia-associated delirium (particularly in salicylism) may occur despite a "normal" peripheral blood glucose [235]. A wide range of clinical presentations have been described, including diaphoresis, nausea, tachycardia, tremor, hypothermia, focal neurological deficits, and CNS agitation, confusion, or depression.…”

Section: Dextrosementioning

confidence: 99%

Drugs and pharmaceuticals: management of intoxication and antidotes

Smith

2010

Experientia Supplementum

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The treatment of patients poisoned with drugs and pharmaceuticals can be quite challenging. Diverse exposure circumstances, varied clinical presentations, unique patientspecific factors, and inconsistent diagnostic and therapeutic infrastructure support, coupled with relatively few definitive antidotes, may complicate evaluation and management. The historical approach to poisoned patients (patient arousal, toxin elimination, and toxin identification) has given way to rigorous attention to the fundamental aspects of basic life supportairway management, oxygenation and ventilation, circulatory competence, thermoregulation, and substrate availability. Selected patients may benefit from methods to alter toxin pharmacokinetics to minimize systemic, target organ, or tissue compartment exposure (either by decreasing absorption or increasing elimination). These may include syrup of ipecac, orogastric lavage, activated single-or multi-dose charcoal, whole bowel irrigation, endoscopy and surgery, urinary alkalinization, saline diuresis, or extracorporeal methods (hemodialysis, charcoal hemoperfusion, continuous venovenous hemofiltration, and exchange transfusion). Pharmaceutical adjuncts and antidotes may be useful in toxicant-induced hyperthermias. In the context of analgesic, anti-inflammatory, anticholinergic, anticonvulsant, antihyperglycemic, antimicrobial, antineoplastic, cardiovascular, opioid, or sedative-hypnotic agents overdose, N-acetylcysteine, physostigmine, L-carnitine, dextrose, octreotide, pyridoxine, dexrazoxane, leucovorin, glucarpidase, atropine, calcium, digoxin-specific antibody fragments, glucagon, high-dose insulin euglycemia therapy, lipid emulsion, magnesium, sodium bicarbonate, naloxone, and flumazenil are specifically reviewed. In summary, patients generally benefit from aggressive support of vital functions, careful history and physical examination, specific laboratory analyses, a thoughtful consideration of the risks and benefits of decontamination and enhanced elimination, and the use of specific antidotes where warranted. Data supporting antidotes effectiveness vary considerably. Clinicians are encouraged to utilize consultation with regional poison centers or those with toxicology training to assist with diagnosis, management, and administration of antidotes, particularly in unfamiliar cases.

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Intubation Appears Safe in Moderate Salicylate Poisoning But Not Necessarily in Severe Poisoning

Mullins

2024

The Journal of Emergency Medicine

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Reversal of salicylate-induced euglycemic delirium with dextrose

Cited by 3 publications

References 11 publications

83-year-old Woman with a Fever and Emesis

83-year-old Woman with a Fever and Emesis

Drugs and pharmaceuticals: management of intoxication and antidotes

Intubation Appears Safe in Moderate Salicylate Poisoning But Not Necessarily in Severe Poisoning

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