Salicylate Intoxication Treated with Intermittent Positive-pressure Respiration

Freier, S.; Neal, B; Nisbet, H. I. A.; Rees, G. Jackson; Wilson, Frank

doi:10.1136/bmj.1.5031.1333

Cited by 17 publications

(3 citation statements)

References 8 publications

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“…One retrospective review of patients with salicylate intoxication who had been placed on mechanical ventilation at conventional settings found development of a respiratory acidosis, which led to overall worsening of neurologic toxicity by allowing more salicylate to pass into the CNS. 41 On the other hand, the older literature cites the case of a child with salicylate poisoning who was successfully treated with intermittent positive pressure ventilation after he was paralyzed, 42 and animal experiments on acute respiratory failure following salicylate-induced hyperventilation found no pulmonary or arterial blood gas abnormalities in 5 sheep that were paralyzed and ventilated at normal tidal volume and respiratory rate. 43 Alkalinization of the urine is paramount if the patient is still making large amounts of urine to prevent reabsorption of salicylates, 44 and potassium administration prevents hypokalemia and acidification of the urine.…”

Section: Renal Replacement Therapy Is Recommended Whenmentioning

confidence: 99%

Dialysis in the poisoned patient

Bayliss

2010

Hemodialysis International

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Patients who ingest toxic substances may require extracorporeal removal of the poisons or their toxic metabolites if native renal clearance is not sufficient because of acute kidney injury, acuity of symptoms, or burden of toxin. Here, a case is presented, and the literature on renal replacement therapy in the event of acute intoxication is reviewed. Extracorporeal therapy efficacy is examined in terms of the characteristics of the toxin (molecular size, charge, protein, or lipid binding); the patient (body habitus and volume of distribution); and the process (membrane effects on extraction ratios and sieving, role of blood, and dialysate flow rates). The choice of extracorporeal therapy and hemodialysis prescriptions for specific poisonings are discussed.

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Section: Renal Replacement Therapy Is Recommended Whenmentioning

confidence: 99%

Dialysis in the poisoned patient

Bayliss

2010

Hemodialysis International

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“…The hyperventilation of severe salicylate poisoning, with its dangers of hyperpyrexia, exhaustion and gross biochemical disturbances, may be averted by correct pulmonary ventilation, assisted by the use of muscle relaxants (Frier et al, 1957;Celander and Haglund, 1958).…”

Section: Therapeutic Usesmentioning

confidence: 99%

The Use of Muscle Relaxants in Infants and Children

Bush

1963

British Journal of Anaesthesia

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The belief that the use of muscle relaxants in infants and children is both unnecessary and dangerous has not been substantiated by subsequent clinical experience. The important advances that have been made recently in paediatric anaesthesia are due largely to the introduction of muscle relaxants, which have reduced the need for toxic agents to a minimum and have emphasized the importance of control of pulmonary ventilation. Furthermore, muscle relaxants now play an important role in the management of a wide variety of medical and surgical conditions.

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“…Reference has been made elsewhere (Freier et al, 1957) to the pyrexia and exhaustion which may accompany increased respiratory effort. In two cases of hyaline membrane syndrome described by Cook and his colleagues (1957) the metabolic rate was increased by 400 per cent.…”

Section: Avoidance Of Respiratory Stimulantsmentioning

confidence: 99%