salicylism

サリチリズム、サリチル酸中毒

関

salicylate intoxication

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/16 01:15:51」(JST)

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Aspirin poisoning
Classification and external resources
ICD-10	T39.0
ICD-9	965.1
MedlinePlus	002542
eMedicine	emerg/514

Aspirin poisoning or salicylism can be acute or chronic. A single overdose may cause acute poisoning; continuous usage of an elevated dosage over long periods of time may cause chronic poisoning. Acute overdose has a mortality rate of 2%.^{[citation needed]} Chronic overdose is more commonly lethal with a mortality rate of 25%;^{[citation needed]} chronic overdose may be especially severe in children. Symptoms may range from mild nausea and vomiting, abdominal pain, lethargy, tinnitus, and dizziness to severe such as seizure or cerebral edema depending on the dose consumed.

Toxicity is managed with a number of potential treatments including: activated charcoal, intravenous dextrose and normal saline, sodium bicarbonate, and dialysis.

Presentation

Main symptoms of aspirin overdose.

Aspirin overdose has potentially serious consequences, sometimes leading to significant morbidity and death. Patients with mild intoxication frequently have nausea and vomiting, abdominal pain, lethargy, tinnitus, and dizziness. More significant signs and symptoms occur in more severe poisonings and include hyperthermia, tachypnea, respiratory alkalosis, metabolic acidosis, hypokalemia, hypoglycemia, hallucinations, confusion, seizure, cerebral edema, and coma. The most common cause of death following an aspirin overdose is cardiopulmonary arrest usually due to pulmonary edema.

Clinical Evaluation

Mild (150 mg/kg)	Moderate (150-300 mg/kg)	Severe (300-500 mg/kg)
No toxicity expected	Mild to moderate toxicity expected	Life-threatening toxicity expected
Nausea, vomiting, dizziness	Nausea, vomiting, tinnitus, headache, confusion, hyperventilation, tachycardia, fever	Delirium, hallucinations, convulsions, coma, respiratory arrest

Pathophysiology

Acute aspirin or salicylates overdose or poisioning can cause initial metabolic alkalosis though metabolic acidosis ensues thereafter. The acid-base, fluid, and electrolyte abnormalities observed in salicylate toxicity can be grouped into three broad phases:

• Phase I: Characterized by hyperventilation resulting from direct respiratory center stimulation, leading to respiratory alkalosis and compensatory alkaluria. Potassium and sodium bicarbonate are excreted in the urine. This phase may last as long as 12 hours.
• Phase II: Characterized by paradoxic aciduria in the presence of continued respiratory alkalosis occurs when sufficient potassium has been lost from the kidneys. This phase may begin within hours and may last 12-24 hours.
• Phase III: Characterized by dehydration, hypokalemia, and progressive metabolic acidosis. This phase may begin 4-6 hours after ingestion in a young infant or 24 hours or more after ingestion in an adolescent or adult.

Diagnosis

The acutely toxic dose of aspirin is generally considered greater than 150 mg per kg of body mass. Moderate toxicity occurs at doses up to 300 mg/kg, severe toxicity occurs between 300 to 500 mg/kg, and a potentially lethal dose is greater than 500 mg/kg. Chronic toxicity may occur following doses of 100 mg/kg per day for two or more days.

Monitoring of biochemical parameters such as electrolytes and solutes, liver and kidney function, urinalysis, and complete blood count is undertaken along with frequent checking of salicylate and blood sugar levels. Arterial blood gas assessments will typically find respiratory alkalosis early in the course of the overdose due to hyperstimulation of the respiratory center, and may be the only finding in a mild overdose. An anion-gap metabolic acidosis occurs later in the course of the overdose especially if it is a moderate to severe overdose, due to the increase in protons (acidic contents) in the blood.

The diagnosis of poisoning usually involves measurement of plasma salicylate, the active metabolite of aspirin, by automated spectrophotometric methods. Plasma salicylate levels generally range from 30–100 mg/L (3–10 mg/dL) after usual therapeutic doses, 50–300 mg/L in patients taking high doses and 700–1400 mg/L following acute overdose. Patients may undergo repeated testing until their peak plasma salicylate level can be estimated. Optimally, plasma levels should be assessed four hours after ingestion and then every two hours after that to allow calculation of the maximum level, which can then be used as a guide to the degree of toxicity expected. Patients may also be treated according to their individual symptoms.

Treatment

When aspirin overdose is suspected, immediately contact a doctor, or any medical professional if no doctor is available. All overdosed patients should be conveyed to a hospital immediately for assessment. Initial treatment of an acute overdose involves resuscitation followed by gastric decontamination by administering activated charcoal, which adsorbs the aspirin in the gastrointestinal tract. Stomach pumping is no longer routinely used in the treatment of poisonings but is sometimes considered if the patient has ingested a potentially lethal amount less than one hour before presentation. Inducing vomiting with syrup of ipecac is NOT recommended. Repeated doses of charcoal have been proposed to be beneficial in cases of aspirin overdosing, although one study found that they might not be of significant value. Regardless, most clinical toxicologists will administer additional charcoal if serum salicylate levels are increasing.

Intravenous fluids

Intravenous fluids containing dextrose such as D5W are recommended to keep a urinary output between 2 and 3 ml/kg/h.

Alkalinization of the urine

Sodium bicarbonate is given in a significant aspirin overdose (salicylate level greater than 35 mg/dl 6 hours after ingestion) regardless of the serum pH as it enhances elimination of aspirin in the urine. It is given until a urine pH between 7.5 and 8.0 is achieved.

Dialysis

Hemodialysis can be used to enhance the removal of salicylate from the blood. Hemodialysis is usually used in severely poisoned patients; for example, patients with significantly high salicylate blood levels [ 7.25 mmol/L (100 mg/dL) in acute ingestions or 40 mg/dL in chronic ingestions], or significant neurotoxicity (agitation, coma, convulsions), renal failure, pulmonary edema, or cardiovascular instability. Hemodialysis also has the advantage of restoring electrolyte and acid-base abnormalities while removing salicylate

Epidemiology

During the latter part of the 20th century, the number of poisonings from salicylates declined, mainly because of the increased popularity of other over-the-counter analgesics such as paracetamol (acetaminophen). Fifty-two deaths involving single-ingredient aspirin were reported in the United States in 2000; however, in all but three of these cases, the reason for the ingestion of lethal doses was intentional—predominantly suicidal.

References

See also

• 1918 flu pandemic

External links

• Salicylate Poisoning by Blaine (Jess) Benson
• Reingardiene, D; Lazauskas, R (2006). "[Acute salicylate poisoning].". Medicina (Kaunas, Lithuania) 42 (1): 79–83. PMID 16467617. 

UpToDate Contents

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• 1. 成人におけるサリチル酸（アスピリン）中毒 salicylate aspirin poisoning in adults
• 2. 小児および思春期におけるサリチル酸中毒 salicylate poisoning in children and adolescents
• 3. アスピリン：リウマチ性疾患における作用機序、主な毒性、および使用 aspirin mechanism of action major toxicities and use in rheumatic diseases
• 4. 非ステロイド性抗炎症剤（NSAIDs）：作用機序 nsaids mechanism of action
• 5. 小児における急性中毒性代謝性脳症 acute toxic metabolic encephalopathy in children

English Journal

• Falsely normal anion gap in severe salicylate poisoning caused by laboratory interference.

• Jacob J, Lavonas EJ.SourceRocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, CO, USA. jeena2010.jj@gmail.com
• Annals of emergency medicine.Ann Emerg Med.2011 Sep;58(3):280-1. Epub 2011 Apr 14.
• Severe salicylate poisoning is classically associated with an anion gap metabolic acidosis. However, high serum salicylate levels can cause false increase of laboratory chloride results on some analyzers. We present 2 cases of life-threatening salicylate poisoning with an apparently normal anion gap
• PMID 21492961

• Excellent clinical results with a new preparation for chemical peeling in acne: 30% salicylic acid in polyethylene glycol vehicle.

• Dainichi T, Ueda S, Imayama S, Furue M.SourceDepartment of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. dainichi@med.kurume-u.ac.jp
• Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].Dermatol Surg.2008 Jul;34(7):891-9; discussion 899.
• BACKGROUND: Chemical peeling by salicylic acid in ethanol or another vehicle may be accompanied by stinging and burning followed by postinflammatory hyperpigmentation in the treated area, or salicylism. We have developed a new formulation: 30% salicylic acid in polyethylene glycol (SA-PEG). A topica
• PMID 18363720

Japanese Journal

• 慈大式人工腎臓 "Jikei ELECTRO-DIALYZER"の研究 第6報: Salicylate透析に関する実験的研究

• 泌尿器科紀要 6(11), 1059-1072, 1960-11
• NAID 120002117047

Related Pictures

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★リンクテーブル★

リンク元	「サリチル酸中毒」「サリチリズム」「salicylate intoxication」

「サリチル酸中毒」

　　[★]

英

salicylism、salicylate intoxication

関

サリチリズム

病態

• 酸化的リン酸化ATP↓→代謝性アシドーシス

• 脳浮腫、脳障害

症状

• 悪心・嘔吐、消化管出血、意識レベル↓、麻痺、呼吸停止、昏睡、脳死、心不全(ARDS)、不整脈

「サリチリズム」

　　[★]

英

salicylism

関

サリチル酸中毒

-サリチル酸中毒

英

salicylate poisoning

-salicylism

「salicylate intoxication」

　　[★]

• サリチル酸中毒

関

salicylism