Salicylate toxicity masquerading as malignant hyperthermia

Candy,; Morrison,; Paton,; Logan, Stuart; Lawson,

doi:10.1046/j.1460-9592.1998.00209.x

Cited by 16 publications

(3 citation statements)

References 5 publications

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“…Severe hyperthermia due to uncoupled oxidative phosphorylation is an accepted complication of salicylate poisoning; succinylcholine was not reportedly administered, essentially excluding a diagnosis of malignant hyperthermia. 5,15 The serum salicylate concentration is one marker of the severity of salicylate poisoning. The patient with the highest salicylate concentration (Patient 1, 143 mg ⁄ dL) survived intact.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Ventilation Was Associated with Acidemia in a Case Series of Salicylate‐poisoned Patients

Stolbach

Hoffman

Nelson

2008

Academic Emergency Medicine

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Objectives: Despite little empiric evidence, mechanical ventilation (MV) in the setting of salicylate poisoning is considered by many to be harmful. When salicylate-poisoned patients are ventilated at conventional settings, the respiratory alkalosis is abolished, more salicylate is able to pass into the central nervous system (CNS), and neurotoxicity worsens. The objective of this study was to identify a relationship between MV, acidosis, and outcome in salicylate-poisoned patients. Methods:The authors electronically searched a poison control center (PCC) database (2001)(2002)(2003)(2004)(2005)(2006)(2007) for patients with salicylate poisoning, defined as a serum concentration >50 mg ⁄ dL, who had MV listed as a therapy. For the 7-year study period, a total of 3,144 salicylate-poisoning cases were identified. Eleven patients met the inclusion criteria of having both salicylate concentrations >50 mg ⁄ dL and required MV; only 7 of them had post-MV data available. Results:In all seven patients with post-MV blood gas data, the post-MV pH was <7.4. In five of six patients with recorded PCO 2 , the post-MV PCO 2 was >50 mm Hg. Two of the seven patients in the study group died following intubation (two patients died within 3 hours [serum salicylate concentrations, 85 and 79 mg ⁄ dL, respectively]). Another patient sustained severe neurologic injury (serum salicylate concentration, 84 mg ⁄ dL). The other four patients were ultimately discharged home. In the three patients with the worst clinical outcome, deterioration was reported within hours of intubation. Conclusions:Inadequate MV of patients with salicylate poisoning is associated with respiratory acidosis, acidemia, and clinical deterioration in this series of cases. This supports warnings about the danger of improper MV in patients with salicylate poisoning. A prospective study should be performed.ACADEMIC EMERGENCY MEDICINE 2008; 15:866-869 ª

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Section: Discussionmentioning

confidence: 99%

Mechanical Ventilation Was Associated with Acidemia in a Case Series of Salicylate‐poisoned Patients

Stolbach

Hoffman

Nelson

2008

Academic Emergency Medicine

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“…Use of topical NSAIDs has resulted in numerous complications, 3 including acute renal failure 12 and exacerbations of asthma. 13 Salicylate toxicity has occurred in children treated with topical agents, 14 and there are now several reports of central nervous system toxicity due to topical doxepin. 8,9 There is significant potential for toxicity due to systemic effects of other component drugs, such as anticonvulsant medications, which can produce bone marrow suppression and liver damage.…”

Section: Discussionmentioning

confidence: 99%

Use of compounded topical analgesics—results of an internet survey☆

Ness

Jones

Smith

2002

Regional Anesthesia and Pain Medicine

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Topically applied single or multiagent analgesics compounded by specialty pharmacies are utilized by an unknown number of pain clinicians to unknown effect. To assess the use and perceived efficacy of these agents, an e-mail survey of members of the American Society of Regional Anesthesia and Pain Medicine was performed. Response rate was low, but identified use of compounded topical agents throughout the United States. Of the 120 clinicians responding, 27% (n = 32) reported that they prescribed compounded topical analgesics containing 1 to 5 agents (mean + SEM; 2.6 +/- 0.2) in their practice 3.5 +/- 0.6 times per month. Use of 36 different agents of varying concentrations was reported. These clinicians perceived that 43% +/- 4% of treated patients responded favorably to the topical agents with an average of 47% +/- 3% pain relief and few side effects. Despite favorable reports of benefit, most clinicians perceived use of such compounded agents in their regions to generally be "little or none."

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“…Certainly the experience with topical nonsteroidal anti‐inflammatories must be kept in mind where the topical application of agents resulted in numerous complications 99 including acute renal failure 112 and exacerbation of asthma 113 . Salicylate toxicity has occurred in children treated with topical agents 114 . At present, the benefits gained by using multiagent topical agents are not known; however, it is known that their use can carry significant and potentially life‐threatening risks.…”

Section: Compounded Topical Agentsmentioning

confidence: 99%

Pharmacology of Peripheral Analgesia

Ness

2001

Pain Practice

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Pain may begin in the periphery with activation of nociceptor transducers. The present article reviews the pharmacology of drug action at the level of the primary afferent by discussing the following: [1] agents which block transduction processes (vanilloids, sodium ion channel blockers, antiserotonergic agents, antipurinergic agents); [2] agents inhibiting the transducer site (opioids, cannabinoids, alpha adrenergic agents); [3] agents blocking transducer-based modulation processes (anti-inflammatories, antikinin agents, antitachykinins); and [4] agents which block primary afferentrelated modification processes (antineurotrophins). There is a clear role for many of these agents in the treatment of inflammatory pain and they have potential benefits for neuropathic pain with peripheral triggers.

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Salicylate toxicity masquerading as malignant hyperthermia

Abstract: We report a case of hyperpyrexia presumed due to topical salicylate toxicity occurring immediately following general anaesthesia for appendicectomy in an eleven year old boy. Some of the features strongly suggested the diagnosis of malignant hyperpyrexia.

Cited by 16 publications

References 5 publications

Mechanical Ventilation Was Associated with Acidemia in a Case Series of Salicylate‐poisoned Patients

Mechanical Ventilation Was Associated with Acidemia in a Case Series of Salicylate‐poisoned Patients

Use of compounded topical analgesics—results of an internet survey☆

Pharmacology of Peripheral Analgesia

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