Aspirin Overdose; Respiratory Alkalosis or Metabolic Acidosis - USMLE Forums
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  #1  
Old 02-21-2011
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Poison Aspirin Overdose; Respiratory Alkalosis or Metabolic Acidosis

I had a question this morning, it looks like very simple... But I missed it. At the first answer it then I'll put explanation.

A 5 yo girl consumes fifty 325 mg tab of aspirin. The initial disturbance of acid base balance that would be expected to occur in this patient is the result of which following disorder?
- Respiratory alkalosis
- Metabolic acidosis
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  #2  
Old 02-21-2011
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Isn't it a combination of both respiratory alkalosis and metabolic acidosis?
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Old 02-21-2011
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In acute toxicity (early ingestion, INITIAL disturbance) you have hyperventilation and respiratory alkalosis

After 3-4 hours (according to Kaplan) you will have primarily metabolic acidosis

Hope that helps =)
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Which answer we need to pick - That is the question...
Just choose the answer from (I removed others):
- Respiratory alkalosis
- Metabolic acidosis
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Old 02-21-2011
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Respiratory alkalosis-

because it says initial disturbance
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Quote:
Originally Posted by ms.med View Post
Respiratory alkalosis-

because it says initial disturbance
Yes - you correct!

Explanation:
Salicylate overdose → resperatory alcalosis occur early and is followed by metabolic acidosis.

Additionally from here: http://emedicine.medscape.com/article/1009987-overview
Salicylates stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis. Salicylates also interfere with the Krebs cycle, limit production of ATP, and increase lactate production, leading to ketosis and a wide anion-gap metabolic acidosis. Adult patients with acute poisoning usually present with a mixed respiratory alkalosis and metabolic acidosis. However, respiratory alkalosis may be transient in children such that metabolic acidosis may occur early in the course. Patients with mixed acid-base disturbances have been found to have normal anion-gap metabolic acidosis; therefore, normal anion-gap acidosis does not exclude salicylate.

Last edited by deyneko; 02-21-2011 at 10:07 AM. Reason: I added somt useful info
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Old 02-21-2011
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But remember to TX OD with drugs that make urine ALKALINE.

Ex. NaHCO3, KCl, Sodium Citrate..
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Old 02-21-2011
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Quote:
Originally Posted by patelMD View Post
But remember to TX OD with drugs that make urine ALKALINE.

Ex. NaHCO3, KCl, Sodium Citrate..
and the bicarbonate will correct the blood ph as well right? or is it just to aid the excretion?
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Old 02-21-2011
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Quote:
Originally Posted by doctorsmonsters View Post
and the bicarbonate will correct the blood ph as well right? or is it just to aid the excretion?
Well yes, blood would receive the bicarb, so it would become alkaline, which is how the filtrate urine would be alkaline.
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