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Methyl salicylate Poisoning (MONITORING (Plasma salicylate concentration,…
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- also known as wintergreen oil
- organic ester naturally produced by many species of plants, particularly wintergreens\
- forms a colorless to yellow or reddish liquid
- flavouring agent, fragrance, OTC
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Evaluate patient on salicylate toxicity which includes details on:
- the amount applied
- if patient takes the medication on regular basis
- intentional or unintentional intoxication
- if the patient has underlying medical problems or takes any medication regularly - any symptoms experienced such as fever, vomiting, respiratory distress or nausea.
- vertigo
- tachycardia
- hallucinations
- agitation
- nausea
- find out the real cause of sudden death of both victim of OTC drug users.
- show the instruction of use clearly on the label of all drugs including OTC medications.
- follow the instructions on the label of Ultra Strength Bengay
- vital signs monitoring and evaluation for hyperpnea, tinnitus, CNS disturbance and diaphoresis.
- lung examination to monitor signs of pulmonary edema such as crackles and hypoxemia which is an indication for hemodialysis
a) Plasma salicylate concentration
- should be measured every two to four hours frequently until clinical improvement is observed
- Therapeutic range is 10 to 30 mg/dL
- patients show signs of toxicity when the plasma concentration exceeds 30 to 50 mg/dL
b) Other test
- ABG
- plasma creatinine
- chest radiography
- urinalysis
- electrocardiogram
- complete blood count
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A detailed and reliable account of the drugs taken should be noted
- drug name
- Amount
- Preparation type
- Time of ingestion
- Application
- Assess airway, breathing and circulation
- Assess respiratory function including respiratory rate, tidal volume, oxygen saturation, arterial blood gases
- Assess vital signs including pulse, BP, ECG, temperature, blood glucose and weight
- Assess patient mental status
a) Reducing further absorption and enhance elimination
- Activated charcoal 50g given orally or nasogastric tube
b) If metabolic acidosis is present
- If serum potassium is normal, intravenous sodium bicarbonate (1.5L of 1.26% sodium bicarbonate or 225ml 8.4%) over 2 hours
- If the potassium is low, correct the potassium level first before giving the bicarbonate
c) Severe intoxication
- Haemodialysis (most efficient method of removing salicylates from the blood)
- Significant adverse effects can be seen if the levels of salicylate in blood is greater than 300 μg/mL
- Not to be discharge until the plasma salicylate concentration is become normal
- High therapeutic doses of salicylate are associated with a primary respiratory alkalosis and lead to secondary compensatory metabolic acidosis which characterized by a decrease in blood pH and a low plasma bicarbonate concentration
- Reduced in PCO2 concentration caused decreased in bicarbonate renal tubular reabsorption and caused increased in excretion of Sodium, Potassium and water lead to hyponatremia, hypokalemia and dehydration state
- Toxic doses of salicylates may impairs renal function due to the accumulation of sulfuric and phosphoric acids
- High dose of salicylate could cause hyperglycemia and glycosuria lead to depletion of glycogen storage in body due to the release of epinephrine