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Filed under: humanity, paramedic Tagged: paramedic, syria
Salicylate toxicity in the absence of anion gap metabolic acidosis. Bauer S, Darracq MA. Am J Emerg Med 2016 Jul;34(7):1328.e1-3
Moderate-to-severe salicylate toxicity typically presents with a combined metabolic acidosis and respiratory alkalosis. Often, the arterial blood gas shows a pH quite near the normal 7.4, but with decreased pCO2 and decreased bicarbonate.
However, occasional case reports have shown that in these cases the anion cap may, rarely, but normal or even negative. This seems to be related to specific electrodes that measure chloride level loosing selectivity as they age, and mistaking the salicylate ion for chloride. This artifactual hyperchloremia lowers or abolishes the anion gap.
No need to go into the details of this case, which again illustrates this phenomenon. The key take-home lesson: If you suspect salicylate toxicity in a patient with a metabolic acidosis, the absence of an elevated anion gap does not rule-out the diagnosis.
#Infografika - Preoperatív kivizsgálás
Loperamide is the active ingredient in Immodium, an over-the-counter antidiarrheal agent which also has μ-opioid receptor agonist activity. With therapeutic oral dosing, loperamide acts on μ-opioid receptor in the gastrointestinal tract and does not enter the central nervous system. At recommended doses, opioid effects on the central nervous system are not observed, there is no […]