Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning
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 resp...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-01-01
|
| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2017/6835471 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832549920410697728 |
|---|---|
| author | Shannon M. Fernando Valérie Charbonneau Hans Rosenberg |
| author_facet | Shannon M. Fernando Valérie Charbonneau Hans Rosenberg |
| author_sort | Shannon M. Fernando |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-2e823df32d4641b5800434378085449c |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-2e823df32d4641b5800434378085449c2025-02-03T06:08:14ZengWileyCase Reports in Critical Care2090-64202090-64392017-01-01201710.1155/2017/68354716835471Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate PoisoningShannon M. Fernando0Valérie Charbonneau1Hans Rosenberg2Department of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, CanadaSalicylates 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.http://dx.doi.org/10.1155/2017/6835471 |
| spellingShingle | Shannon M. Fernando Valérie Charbonneau Hans Rosenberg Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning Case Reports in Critical Care |
| title | Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning |
| title_full | Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning |
| title_fullStr | Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning |
| title_full_unstemmed | Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning |
| title_short | Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning |
| title_sort | hypercapnea and acidemia despite hyperventilation following endotracheal intubation in a case of unknown severe salicylate poisoning |
| url | http://dx.doi.org/10.1155/2017/6835471 |
| work_keys_str_mv | AT shannonmfernando hypercapneaandacidemiadespitehyperventilationfollowingendotrachealintubationinacaseofunknownseveresalicylatepoisoning AT valeriecharbonneau hypercapneaandacidemiadespitehyperventilationfollowingendotrachealintubationinacaseofunknownseveresalicylatepoisoning AT hansrosenberg hypercapneaandacidemiadespitehyperventilationfollowingendotrachealintubationinacaseofunknownseveresalicylatepoisoning |