ayeshah_l
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A 5-year-old girl is admitted to the Children's Hospital after swallowing an undisclosed number of her mother's ASA tablets. She is hypotensive, flushed and tachypneic. Which of the following acid-base disturbances would be most likely?
1) pH low ; HCO3 low ; pCO2 high
2) pH normal ; HCO3 high; pCO2 low
3) pH low; HCO3 low; pCO2 high
4) pH low; HCO3 high; pCO2 low
5) pH high; HCO3 high; pCO2 high
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| dev
Forum Guru
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it could be 2?
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| ayeshah_l
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can u explain?
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| dev
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initailly tere is a respiratory alkalosis die to hyperventilationand hyperpnea.followed by aningap metabolic acidosis.this is what i think.
:idea:
bye the way whats the answer :?: 
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| ayeshah_l
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i am not sure of the answer dev. will let u know as soon as i figure it out!!
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| Hamidi
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Salisylate toxicity differs in adults and kids.
In adults they get resp Alkalosis( stimulating resp center)in early stage to Metabolic Acidosis in latter stage(Due to lots of reasons like inhibition of kerb cyle,uncoupaling of ox-phosphorytion etc)
I kids there is no stimulation of resp center so they get met acidosis and to compensate that .....resp alkalosis
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| ayeshah_l
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so the correct answer is 2?
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| mash
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ASA toxicity in children leads to high AG metabolic acidosis and compensatory respiratory alkalosis (due to tachypnea)
so, pH shud be low or normal(due to compensation)
HCO3- shud be low(MA)
PaCO2 shud be low(respi compensation)
none of the choices show this AB status(1 and 3 are same)
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| icecool
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Mash has pointed it out that 1) and 3) are the same, so I am wondering wether the q is from a reliable source.
I think the basic pathophysiology is acidosis, you have ASA extraacids, TCA inhibition and uncoupling (--> inc lactic acids), proximal tubular damage leading to dec HCO3 reabsorption, and pH should be low, so is HCO3. Although compensation does occur, as we all know, it never brings pH above normal. I would go for 3)/1). What I am not sure is why PCO2 is high? Tachypnea with high PCO2 sounds like acute respiratory distress syndrome, which can be associated with shock (though most often septic) and other organ failure such as liver and kidney. In this case, the kid is hypotensive and although not mentioned, probably has tubular renal failure, just guess.
icecool
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