salicylate poisoning by dr praythiesh bruce mbbs
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Transcript of salicylate poisoning by dr praythiesh bruce mbbs
PEDIATRICSSEMINARPRESENTATION
BY
M.S.PRAYTHIESH BRUCE
FINAL MBBS,SMIMS,
KULASEKARAM
SALICYLATE POISONING IN CHILDREN
MOST COMMON POISONING DANGEROUS POISONING IN CHILDREN
OCCUR DUE TO;
OVERDOSE IN SICK CHILD
USE OF OIL OF WINTER GREEN;
SALICYLATE POWDER OR OINTMENT ON BROKEN SKIN
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TISSUEGLYCOLYSIS-NEUROGLYCOPENIA-DEPRESSION OFRESPIRATORY CENTER
UNCOUPLING OF OXIDATIVE RESPIRATORY ACIDOSIS C CATECOLAMINES PHOSPHORYLATION HEPATICGLYCOGENOLYSIS
SSALICYLATE INTOXICATION GLUCOCORTICOIDS DS
02CONSUMPTION
CO2 PRODUCTION
STIMULATION OF RESPIRATORY CENTRE STIMULATION OF CTZ INHIBIT AMINO LIPID METABOLISM
RESPIRATORY RATE AND DEATH …………………….
…… RESPIRATORY ALKALOSIS
HCO3
BUFFERING ACTIVITY METABOLIC ACIDOSIS HYPERPYREXIA
SWEATING
VOMITING AMINO ACIDURIA,KETOSIS,SERUM P .. PYRUVIC ACID AND LACTIC ACID
PATHOPHYSIOLOGY OF SALICYLATE POISONING
FATAL DOSE,FATAL PERIOD
FATAL DOSE; 200MG/KGBODY WEIGHT IS TOXIC
FATAL PERIOD;ACUTE INTOXICATION 1-3 HRS
VARIES FROM FEW MINUTES TO SEVERAL HOURS
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CLINICAL FEATURES
MIXED ACID BASE DISTURBANCES OCCUR WITH RESPIRATORY ALKALOSIS
FOLLOWED BY METABOLIC ACIDOSIS
IT CAN AFFECT ALL SYSTEMS OF THE BODY
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GENERAL FEATURES
GASTROINTESTINAL;NAUSEA, VOMITING, EPIGASTRIC, PAIN, HEMATEMESIS,MALENA
RESPIRATORY;TACHYPNEA,HYPERPNEA,INITIALLY FOLLOWED BY ACIDOTIC BREATHING
CNS;HEADACHE LETHARGHYVERTIGO
CVS;TACHYCARDIA
VISION AND HEARING;TINNITUS,DEAFNESS,BLURRING AND VISION
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RENAL;OLIGURIA,ANURIA
FLUID AND ELECTROLYTED DISTURBANCES;DEHYDRATIN,SWEATING VOMITING,OVERBREATHING,HYPER OR HYPONATREMIA
COAGULATION SYSTEM;BLEEDING TENDENCY OCCURS
METABOLIC DISTURBANCES;RESPIRATORY ALKALOSIS FOLLOWED BY METABOLIC ACIDOSIS
HYPO/HYPERGLYCEMIA,GLUCOSURIA
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REYE SYNDROMECEREBRAL OEDEMARESPIRATORY FAILURESEVERE CARDIOVASCULAR COLAPSEGI BLEEDING
ACUTE RENAL FAILUREACUTE DRUG INDUCED HEPATITIS
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COMPLICATIONS OF SALICYLATE INTOXICATION
LABORATORY INVESTIGATIONS
BLOOD SALICYLATE LEVEL
<50MG/DL50-100MG/DL>100MG/DL
SEVERITY OF POISONING
MILDMODERATESEVERE
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BLOOD LEVEL INVESTIGATIONS DONE AT 6 HOURS OR MORE AFTER SALICYLATE INTOXICATION
HYPOGLYCEMIAHYPONATREMIAHYPOKALEMIAACIDEMIAHYPOPROTHROMBINEMIA
HYPERGLYCEMIAHYPERNATREMIAABNORMAL LIVER FUNCTION TESTSALTERED RENAL FUNCTION TESTS
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LABORATORY INVESTIGATIONS
TREATMENT
AIRWAY STABILISATION
RESTORATION OF CIRCULATION
REMOVAL OF DRUG FROM THE BODY
CORRECTION OF ACIDOSIS
GASTRIC EMPTYING-SYRUP OF IPECAC AS AN EMETIC
FLUID AND ELECTROLYTE THERAPHY
ACIDOSIS-NAHCO3
SHOCK TREATED BY ALBUMIN 5%
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ACTIVATED CHARCOAL
CATHARSIS
GLUCOSE ADMINISTRATION
ALKALIZATION OF URINE
DIURESIS
HAEMODIALYSIS,HAEMOPERFUSION OR PERITONEAL DIALYSIS
SEIZURES PHENOBARBITONE-(5MG?KG)
HYPOCALCEMIC TETANY -10%SOLUTION OF
CALCIUM GLUCONATE
PROLONGED PROTHROMBIN PARENTAL VITAMIN K
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NALOXONE GIVEN PARENTAL –OPIOD INGESTION
CARDIOGENIC PULMONARY OEDEMA-DIGITALIS GIVEN
RESPIRATORY FAILURE- SUPPORTIVE VENTILATION GIVEN
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INDICATIONS FOR HAEMODIALYSIS/HEMOPERFUSIONRENAL FAILURE
CNS MANIFESTATIONS
UNRESPONSIVE ACIDOSIS(PH<7.1)
BLLOD SALCYLATE LEVEL
NON CARDIOGENIC PULMONARY OEDEMA
PROGRESSIVE DETERIORATION OF PATIENT
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THANK YOU
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