Display options
Cite
Fernando SM, Charbonneau V, Rosenberg H. Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning. Case Rep Crit Care. 2017;2017:6835471doi: 10.1155/2017/6835471.
Fernando, S. M., Charbonneau, V., & Rosenberg, H. (2017). Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning. Case reports in critical care, 20176835471. https://doi.org/10.1155/2017/6835471
Fernando, Shannon M, et al. "Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning." Case reports in critical care vol. 2017 (2017): 6835471. doi: https://doi.org/10.1155/2017/6835471
Fernando SM, Charbonneau V, Rosenberg H. Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning. Case Rep Crit Care. 2017;2017:6835471. doi: 10.1155/2017/6835471. Epub 2017 Mar 29. PMID: 28465843; PMCID: PMC5390632.
Copy Download .nbib Format: NLM
Share it on

Case Rep Crit Care. 2017;2017:6835471. doi: 10.1155/2017/6835471. Epub 2017 Mar 29.

Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning.

Case reports in critical care

Shannon M Fernando, Valérie Charbonneau, Hans Rosenberg

Affiliations

  1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
  2. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

PMID: 28465843 PMCID: PMC5390632 DOI: 10.1155/2017/6835471

Abstract

Salicylates are common substances for deliberate self-harm. Acute salicylate toxicity is classically associated with an initial respiratory alkalosis, followed by an anion gap metabolic acidosis. The respiratory alkalosis is achieved through hyperventilation, driven by direct stimulation on the respiratory centers in the medulla and considered as a compensatory mechanism to avoid acidemia. However, in later stages of severe salicylate toxicity, patients become increasingly obtunded, with subsequent loss of airway reflexes, and therefore intubation may be necessary. Mechanical ventilation has been recommended against in acute salicylate poisoning, as it is believed to take away the compensatory hyperpnea and tachypnea. Despite the intuitive physiological basis for this recommendation, there is a paucity of evidence to support it. We describe a case of a 59-year-old male presenting with decreased level of consciousness and no known history of ingestion. He was intubated and experienced profound hypercarbia and acidemia despite mechanical ventilation with high minute ventilation and tidal volumes. This case illustrates the deleterious effects of intubation in severe salicylate toxicity.

References

  1. Ann Emerg Med. 2003 Apr;41(4):583-4 - PubMed
  2. Clin Toxicol (Phila). 2007;45(2):95-131 - PubMed
  3. Am J Emerg Med. 2009 Nov;27(9):1173.e1-3 - PubMed
  4. Emerg Med Clin North Am. 2014 Nov;32(4):871-87 - PubMed
  5. BMJ Case Rep. 2013 Apr 18;2013:null - PubMed
  6. Ann Pharmacother. 2004 Jul-Aug;38(7-8):1186-8 - PubMed
  7. Am J Emerg Med. 2010 Mar;28(3):383-4 - PubMed
  8. Emerg Med Clin North Am. 2007 May;25(2):333-46; abstract viii - PubMed
  9. Acad Emerg Med. 2008 Sep;15(9):866-9 - PubMed

Publication Types