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The Prompt Treatment of Salicylism with Sodium Bicarbonate

The Prompt Treatment of Salicylism with Sodium Bicarbonate Abstract The ingestion of toxic quantities of salicylate results in alterations of acid-base homeostasis which at times may be profound. The pathogenic mechanisms include hyperventilation secondary to respiratory stimulation, increase in metabolic rate, and disturbances in carbohydrate and lipid metabolism.1-6 Further alterations frequently follow the vomiting and dehydration which are so often associated with ingestion of larger amounts of salicylate. There is no specific antidote for salicylism. Treatment is currently aimed at augmenting elimination of salicylate via the urine or, in severer cases, directly from the blood by hemodialysis or exchange transfusion. Ninety per cent of ingested salicylate is excreted by the kidney. It is eliminated in three forms: free salicylate, salicyluric acid, and salicylglucuronide. At an acid pH, free salicylate accounts for approximately 20% of the total excreted. However, as the urine pH rises above 7.0 both the relative percentage and the total amount of free salicylate increase progressively. References 1. Dodd, K.; Minot, A. S., and Arena, J. M.: Salicylate Poisoning: An Explanation of the More Serious Manifestations , Am. J. Dis. Child. 53: 1435, 1937. 2. Lutwak-Mann, C.: The Effect of Salicylate and Cincophen on Enzymes and Metabolic Processes , Biochem. J. 36:706, 1942. 3. Rapoport, S., and Guest, G. N.: The Effect of Salicylate on the Electrolyte Structure of the Blood Plasma: I. Respiratory Alkalosis in Monkeys and Dogs After Sodium and Methyl Salicylate; The Influence of Hypnotic Drugs and of Sodium Bicarbonate on Salicylate Poisoning , J. Clin. Invest. 24:759, 1945.Crossref 4. Erganian, J. A.; Forbes, G. B., and Case, D. M.: Salicylate Intoxication in the Infant and Young Child: A Report of 13 Cases , J. Pediat. 30:129, 1947.Crossref 5. Kaplan, E. H.; Kennedy, J., and Davis, J.: Effects of Salicylates and Other Benzoates on Oxidative Enzymes of the Tricarboxylic Acid Cycle in Rat Tissue Homogenates , Arch. Biochem. 51:47, 1954.Crossref 6. Tenney, S. M., and Miller, R. M.: Respiratory and Circulatory Actions of Salicylate , Am. J. Med. 19:498, 1955.Crossref 7. Smith, P. K.; Gleason, H. L.; Stall, C. G., and Ogorzalek, S.: Studies on the Pharmacology of Salicylate , J. Pharmacol. & Exper. Therap. 87: 237, 1946. 8. Hoffman, W. S., and Nobe, C.: The Influence of Urinary pH on the Renal Excretion of Salicyl Derivatives During Aspirin Therapy , J. Lab. & Clin. Med. 35:237, 1950. 9. Davis, P. L., and Smith, P. K.: Relation of the Rate of Excretion of Salicylate to Urinary Acidity , Arch. internat. pharmacodyn. 86:303, 1951. 10. MacPherson, C. R.; Milne, M. D., and Evans, B. M.: The Excretion of Salicylate , Brit. J. Pharmacol. 10:484, 1955. 11. Gutman, A. B.; Yu, T. K., and Sirota, J. H.: A Study by Simultaneous Clearance Techniques of Salicylate Excretion in Man: Effect of Alkalinization of the Urine by Bicarbonate Administration; Effect of Probenecid , J. Clin. Invest. 34:711, 1955. 12. Wallace, W. M.: The Use of Salicylate in Pediatrics , Quart. Rev. Pediat. 9:135, 1954. 13. Harvie, F. H., and Singer, R. B.: Salicylate Poisoning , A.M.A. Am. J. Dis. Child. 89:149, 1955. 14. Riley, H. D., and Worley, L.: Salicylate Intoxication , Pediatrics 18:518, 1956. 15. Segar, W. E., and Holliday, M. A.: Physiologic Abnormalities of Salicylate Intoxication , New England J. Med. 259:1191, 1958. 16. Winters, R. W.: Therapy of Salicylate Poisoning , Pediatrics 23:255, 1959. 17. Farber, H. R.; Yiengst, M. D., and Shock, N. W.: The Effects of Therapeutic Doses of Aspirin on the Acid Base Balance of the Blood in Normal Adults , Am. J. Med. Sc. 217:256, 1949. 18. Ryder, H. W.; Shaver, M., and Ferris, E. B., Jr.: Salicylism Accompanied by Respiratory Alkalosis and Toxic Encephalopathy , New England J. Med. 232:617, 1945. 19. Spector, S., and McKhann, C. F.: Respiratory Acidosis and Alkalosis in Children , J. Pediat. 92:227, 1945. 20. Arnold, F. J., Jr.; Hodges, J. B., Jr., and Barta, R. A., Jr., in collaboration with Spector, S.; Sunshine, I., and Wedgewood, R. J.: Evaluation of the Efficacy of Lavage and Induced Emesis in Treatment of Salicylate Poisoning , Pediatrics 23:286, 1959. 21. Keller, W. J.: Rapid Technique for the Determination of Salicylate in Serum or Plasma , Am. J. Clin. Path. 17:415, 1947. 22. Natelson, S.: Routine Use of Ultra Micro Methods in the Clinical Laboratory , Am. J. Clin. Path. 21:1153, 1951. 23. Wheeler, W. E.; Bates, G. D., and Oliver, T. K., Jr.: Measurement of Serum pH with a Micro-Glass Electrode in a Constant Temperature Air Bath, to be published. 24. Singer, R. B.: The Acid-Base Disturbance in Salicylate Intoxication , Medicine 33:1, 1954.Crossref 25. Winters, R. W.; Lowder, J. A., and Ordway, N. K.: Observations on the Plasma Carbon Dioxide Tension During Recovery from Metabolic Acidosis , J. Clin. Invest. 37:640, 1958.Crossref 26. Schreiner, G. E.; Berman, L. B.; Griffen, J., and Fayes, J.: Specific Therapy for Salicylism , New England J. Med. 253:213, 1955.Crossref 27. Done, A. K., and Otterness, L. J.: Exchange Transfusion in the Treatment of Oil of Wintergreen (Methyl Salicylate) Poisoning , Pediatrics 18:80, 1956. 28. Barnett, H. L.; Powers, J. R.; Benward, J. H., and Hartman, A. F.: Salicylate Intoxication in Infants and Children , J. Pediat. 21:214, 1942.Crossref 29. Kaplan, S. A., and del Carmen, F. T.: Experimental Salicylate Poisoning: Observations on the Effects of Carbonic Anhydrase Inhibitor and Bicarbonate , Pediatrics 21:762, 1958. 30. Schwartz, W. B.; Falbriard, A., and Relman, A. B.: An Analysis of Bicarbonate Reabsorption During Partial Inhibition of Carbonic Anhydrase , J. Clin. Invest. 37:744, 1958.Crossref 31. Schwartz, R.; Fellers, F. X.; Knapp, J., and Yaffe, S.: The Renal Response to Administration of Acetazolamide (Diamox) During Salicylate Intoxication , Pediatrics 23:1103, 1959. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Journal of Diseases of Children American Medical Association

The Prompt Treatment of Salicylism with Sodium Bicarbonate

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References (37)

Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0096-6916
DOI
10.1001/archpedi.1960.02070030555001
Publisher site
See Article on Publisher Site

Abstract

Abstract The ingestion of toxic quantities of salicylate results in alterations of acid-base homeostasis which at times may be profound. The pathogenic mechanisms include hyperventilation secondary to respiratory stimulation, increase in metabolic rate, and disturbances in carbohydrate and lipid metabolism.1-6 Further alterations frequently follow the vomiting and dehydration which are so often associated with ingestion of larger amounts of salicylate. There is no specific antidote for salicylism. Treatment is currently aimed at augmenting elimination of salicylate via the urine or, in severer cases, directly from the blood by hemodialysis or exchange transfusion. Ninety per cent of ingested salicylate is excreted by the kidney. It is eliminated in three forms: free salicylate, salicyluric acid, and salicylglucuronide. At an acid pH, free salicylate accounts for approximately 20% of the total excreted. However, as the urine pH rises above 7.0 both the relative percentage and the total amount of free salicylate increase progressively. References 1. Dodd, K.; Minot, A. S., and Arena, J. M.: Salicylate Poisoning: An Explanation of the More Serious Manifestations , Am. J. Dis. Child. 53: 1435, 1937. 2. Lutwak-Mann, C.: The Effect of Salicylate and Cincophen on Enzymes and Metabolic Processes , Biochem. J. 36:706, 1942. 3. Rapoport, S., and Guest, G. N.: The Effect of Salicylate on the Electrolyte Structure of the Blood Plasma: I. Respiratory Alkalosis in Monkeys and Dogs After Sodium and Methyl Salicylate; The Influence of Hypnotic Drugs and of Sodium Bicarbonate on Salicylate Poisoning , J. Clin. Invest. 24:759, 1945.Crossref 4. Erganian, J. A.; Forbes, G. B., and Case, D. M.: Salicylate Intoxication in the Infant and Young Child: A Report of 13 Cases , J. Pediat. 30:129, 1947.Crossref 5. Kaplan, E. H.; Kennedy, J., and Davis, J.: Effects of Salicylates and Other Benzoates on Oxidative Enzymes of the Tricarboxylic Acid Cycle in Rat Tissue Homogenates , Arch. Biochem. 51:47, 1954.Crossref 6. Tenney, S. M., and Miller, R. M.: Respiratory and Circulatory Actions of Salicylate , Am. J. Med. 19:498, 1955.Crossref 7. Smith, P. K.; Gleason, H. L.; Stall, C. G., and Ogorzalek, S.: Studies on the Pharmacology of Salicylate , J. Pharmacol. & Exper. Therap. 87: 237, 1946. 8. Hoffman, W. S., and Nobe, C.: The Influence of Urinary pH on the Renal Excretion of Salicyl Derivatives During Aspirin Therapy , J. Lab. & Clin. Med. 35:237, 1950. 9. Davis, P. L., and Smith, P. K.: Relation of the Rate of Excretion of Salicylate to Urinary Acidity , Arch. internat. pharmacodyn. 86:303, 1951. 10. MacPherson, C. R.; Milne, M. D., and Evans, B. M.: The Excretion of Salicylate , Brit. J. Pharmacol. 10:484, 1955. 11. Gutman, A. B.; Yu, T. K., and Sirota, J. H.: A Study by Simultaneous Clearance Techniques of Salicylate Excretion in Man: Effect of Alkalinization of the Urine by Bicarbonate Administration; Effect of Probenecid , J. Clin. Invest. 34:711, 1955. 12. Wallace, W. M.: The Use of Salicylate in Pediatrics , Quart. Rev. Pediat. 9:135, 1954. 13. Harvie, F. H., and Singer, R. B.: Salicylate Poisoning , A.M.A. Am. J. Dis. Child. 89:149, 1955. 14. Riley, H. D., and Worley, L.: Salicylate Intoxication , Pediatrics 18:518, 1956. 15. Segar, W. E., and Holliday, M. A.: Physiologic Abnormalities of Salicylate Intoxication , New England J. Med. 259:1191, 1958. 16. Winters, R. W.: Therapy of Salicylate Poisoning , Pediatrics 23:255, 1959. 17. Farber, H. R.; Yiengst, M. D., and Shock, N. W.: The Effects of Therapeutic Doses of Aspirin on the Acid Base Balance of the Blood in Normal Adults , Am. J. Med. Sc. 217:256, 1949. 18. Ryder, H. W.; Shaver, M., and Ferris, E. B., Jr.: Salicylism Accompanied by Respiratory Alkalosis and Toxic Encephalopathy , New England J. Med. 232:617, 1945. 19. Spector, S., and McKhann, C. F.: Respiratory Acidosis and Alkalosis in Children , J. Pediat. 92:227, 1945. 20. Arnold, F. J., Jr.; Hodges, J. B., Jr., and Barta, R. A., Jr., in collaboration with Spector, S.; Sunshine, I., and Wedgewood, R. J.: Evaluation of the Efficacy of Lavage and Induced Emesis in Treatment of Salicylate Poisoning , Pediatrics 23:286, 1959. 21. Keller, W. J.: Rapid Technique for the Determination of Salicylate in Serum or Plasma , Am. J. Clin. Path. 17:415, 1947. 22. Natelson, S.: Routine Use of Ultra Micro Methods in the Clinical Laboratory , Am. J. Clin. Path. 21:1153, 1951. 23. Wheeler, W. E.; Bates, G. D., and Oliver, T. K., Jr.: Measurement of Serum pH with a Micro-Glass Electrode in a Constant Temperature Air Bath, to be published. 24. Singer, R. B.: The Acid-Base Disturbance in Salicylate Intoxication , Medicine 33:1, 1954.Crossref 25. Winters, R. W.; Lowder, J. A., and Ordway, N. K.: Observations on the Plasma Carbon Dioxide Tension During Recovery from Metabolic Acidosis , J. Clin. Invest. 37:640, 1958.Crossref 26. Schreiner, G. E.; Berman, L. B.; Griffen, J., and Fayes, J.: Specific Therapy for Salicylism , New England J. Med. 253:213, 1955.Crossref 27. Done, A. K., and Otterness, L. J.: Exchange Transfusion in the Treatment of Oil of Wintergreen (Methyl Salicylate) Poisoning , Pediatrics 18:80, 1956. 28. Barnett, H. L.; Powers, J. R.; Benward, J. H., and Hartman, A. F.: Salicylate Intoxication in Infants and Children , J. Pediat. 21:214, 1942.Crossref 29. Kaplan, S. A., and del Carmen, F. T.: Experimental Salicylate Poisoning: Observations on the Effects of Carbonic Anhydrase Inhibitor and Bicarbonate , Pediatrics 21:762, 1958. 30. Schwartz, W. B.; Falbriard, A., and Relman, A. B.: An Analysis of Bicarbonate Reabsorption During Partial Inhibition of Carbonic Anhydrase , J. Clin. Invest. 37:744, 1958.Crossref 31. Schwartz, R.; Fellers, F. X.; Knapp, J., and Yaffe, S.: The Renal Response to Administration of Acetazolamide (Diamox) During Salicylate Intoxication , Pediatrics 23:1103, 1959.

Journal

A.M.A. Journal of Diseases of ChildrenAmerican Medical Association

Published: May 1, 1960

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