a 67 - pacemaker

[ArchivalUser]

D.....increased osmolal gap........of 9 and inc AG acidosis

[ArchivalUser]

answer could be c or d
given h/o rheumatoid arthritis there is a possibility of accidental overdose of nsaids-salicylates poisoning based on history.Chronic salicylate ingestion should be suspected in this patient with a history of RA.I GO WITH CCC

[ArchivalUser]

CC.

[ArchivalUser]

cud be but in view of tachypnoea which can cause resp alkalosis in addition to met acidosis. but how can u account for hypoglycaemia ???

[ArchivalUser]

correct answer C

Metabolic signs of salicylate toxicity include respiratory alkalosis, anion gap metabolic acidosis, and hyperthermia; other signs and symptoms include depressed level of consciousness, noncardiogenic pulmonary edema, prolonged prothrombin time, hepatic toxicity, and hypoglycemia.
Management of salicylate toxicity includes alkalinization of urine to enhance excretion of salicylates and hemodialysis for severe toxicity.


Salicylates should be 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. Lithium can also cause altered mental status and other neurologic findings, as well as tachycardia due to intravascular volume depletion. Lithium would not be expected to cause fever, metabolic acidosis, or pulmonary edema. 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. Tricyclic antidepressants can cause neurologic symptoms, including seizures and coma. Anticholinergic features such as hyperthermia, dry mouth, flushing, and dilated pupils associated with tricyclic overdose are not seen in this patient.