hero
Forum Elite
Topics: 37
Posts: 460
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59. A 68-year-old woman with hypertension, degenerative joint disease, and depression is hospitalized in the intensive care unit with altered mental status. No information about the patients medications is available.
The patients temperature is 38.3 C (101 F), pulse rate is 118/min, respiration rate is 24/min, and blood pressure is 120/70 mm Hg. No focal neurologic abnormalities are noted, but she is obtunded. Her reflexes are normal. Electrocardiogram shows only sinus tachycardia with no acute changes, and chest radiograph shows bilateral interstitial infiltrates.
Laboratory studies:
Blood urea nitrogen 30 mg/dL
Plasma glucose 65 mg/dL
Serum sodium 148 meq/L
Serum potassium 4.5 meq/L
Serum chloride 108 meq/L
Serum bicarbonate 18 meq/L
Serum creatinine 1.6 mg/dL
Serum osmolarity 302 mosm/L
Which one of the following is the most likely toxin?
A. Ephedrine
B. Salicylate
C. Ethylene glycol
D. Lithium
E. Acetaminophen
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| dr_gladiator
Forum Junior
Topics: 1
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good question.. fever, tachycardia, altered mental status, tachypnea, renal dysfunction.. might be salicylates..
not sure.......
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| cool doctor
Forum Junior
Topics: 1
Posts: 226
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yes it is salicylates
with high AG M acidosis
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| neurom
Forum Senior
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Posts: 127
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I think it is lithium intoxication - D.
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
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| bax
Forum Senior
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C
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| jasmin
Forum Junior
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c
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| kpmle2
Forum Elite
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B. Salicylate
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| hero
Forum Elite
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Posts: 460
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The correct answer is B
Salicylates should be highly considered in this patient with multiple clinical findings consistent with intoxication. The effects of salicylate toxicity include respiratory alkalosis, anion gap metabolic acidosis, and hyperthermia. The increase in insensible water losses and hyperthermia often result in intravascular volume depletion. Salicylates are also associated with a depressed level of consciousness and noncardiogenic pulmonary edema. Other symptoms can include coagulation abnormalities (prolonged prothrombin time), hepatic toxicity, and hypoglycemia.
Chronic salicylate ingestion should be suspected in this patient with a history of degenerative joint disease. Chronic ingestors develop toxicity at lower blood levels than patients with a single acute ingestion. Management includes alkalinization of urine to enhance excretion of salicylates and hemodialysis for severe toxicity.
Ephedrine can produce a sympathomimetic syndrome with tachycardia, hyperthermia, and altered mental status, but metabolic acidosis and pulmonary edema would not be expected.
Ethylene glycol ingestion can produce many of the symptoms this patient is manifesting, including depressed level of consciousness, metabolic acidosis, and pulmonary edema. Ethylene glycol ingestion often results in an osmolar gap, however, and would not be associated with fever.
Lithium can also cause altered mental status and other neurologic findings, as well as tachycardia due to intravascular volume depletion, but it would not be expected to cause fever, metabolic acidosis, or pulmonary edema.
Acetaminophen ingestion alone would not account for the severe depression of consciousness, hyperthermia, metabolic acidosis, or pulmonary edema.
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