Minns Alicia B, Cantrell F Lee, Clark Richard F
Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego, San Diego, California 92103-8925, USA.
J Emerg Med. 2011 May;40(5):515-7. doi: 10.1016/j.jemermed.2010.02.015. Epub 2010 Mar 29.
Salicylate poisoning is a common problem with appreciable morbidity and mortality. We present a case of a patient with a large aspirin ingestion who expired despite aggressive hemodialysis (HD).
A 35-year-old man arrived at the Emergency Department 7.5 h after ingesting 400 tablets of 325-mg aspirin. He was afebrile, the respiratory rate (RR) was 30 breaths/min, heart rate (HR) 120 beats/min, blood pressure (BP) 125/76 mm Hg, and oxygen saturation 99% on room air. His salicylate concentration was 89.6 mg/dL. His initial arterial blood gas: pH 7.48, pCO(2) 21 mm Hg, PaO(2) 97 mm Hg, and bicarbonate 15.8 mmol/L. His initial serum chemistry panel was normal. He received activated charcoal and intravenous hydration with sodium bicarbonate. Two hours after arrival, salicylate concentration was 91.6 mg/dL. The patient became agitated and HD was initiated; 22 h after presentation, repeat salicylate concentration was 88.4 mg/dL and his creatinine was 3.9 mg/dL. A second run of HD was performed. After this, his temperature had risen to 39.06°C (102.3°F), BP 122/64 mm Hg, HR 168 beats/min, RR 43 breaths/min, and oxygen saturation 95% (2 L nasal cannula). His confusion increased, and he died 40 h after his ingestion.
HD is widely advocated in managing severe salicylate intoxications, however, no consensus exists for the duration and best mode of therapy. Patients with severe salicylate poisonings may require extended durations of HD to effectively mitigate toxicity. Additional study is warranted to determine optimal therapy in severe salicylate intoxications.
水杨酸盐中毒是一个常见问题，具有明显的发病率和死亡率。我们报告一例大量服用阿司匹林的患者，尽管进行了积极的血液透析（HD）仍死亡。
一名35岁男性在服用400片325毫克阿司匹林后7.5小时到达急诊科。他无发热，呼吸频率（RR）为30次/分钟，心率（HR）120次/分钟，血压（BP）125/76毫米汞柱，室内空气中氧饱和度为99%。他的水杨酸盐浓度为89.6毫克/分升。他的初始动脉血气分析：pH值7.48，二氧化碳分压（pCO₂）21毫米汞柱，氧分压（PaO₂）97毫米汞柱，碳酸氢盐15.8毫摩尔/升。他的初始血清化学检查结果正常。他接受了活性炭和碳酸氢钠静脉补液治疗。到达后两小时，水杨酸盐浓度为91.6毫克/分升。患者变得烦躁不安，开始进行血液透析；就诊22小时后，复测水杨酸盐浓度为88.4毫克/分升，肌酐为3.9毫克/分升。进行了第二轮血液透析。此后，他的体温升至39.06°C（102.3°F），血压122/64毫米汞柱，心率168次/分钟，呼吸频率43次/分钟，氧饱和度95%（鼻导管吸氧2升）。他的意识障碍加重，服药40小时后死亡。
血液透析在治疗严重水杨酸盐中毒中被广泛提倡，然而，对于治疗的持续时间和最佳方式尚无共识。严重水杨酸盐中毒患者可能需要延长血液透析时间以有效减轻毒性。有必要进行进一步研究以确定严重水杨酸盐中毒的最佳治疗方法。
