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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