M&M - Dr. Bryant

Case 1 - SAlicylate Toxicity

Findings:

• Resp alkalosis followed by metabolic acidosis
• Fever, tinnitus, HTN, tachycardia, hyperventilation, abd pain, GI pain, noncardiac pulmonary edema

Toxicity:

• Toxicity starts at 20-45 mg/dL 
• Toxicity treatment - charcoal if early on, sorbitol, urine alkalinization need a bolus of bicarb then a drip 
• In salicylate toxicity, alkalinization of the urine requires large amounts of bicarb. 
• Hemodialysis is effective at removing free salicylate in cases of AMS, inability to alkalinize the urine, pulmonary edema/ALI and severe acidosis.
• Salicylate level units for toxicity are mg/dL. Chronic level >40 mg/dL and acute level >100 mg/dL requires dialysis.

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Case 2 - Dengue Fever

Pt  with extensive travel presents with viral symptoms - fever, muscle pain, malaise. Had hematuria, persistent fever and tachycardia in the ED. Progressive pulmonary edema

• Dengue virus infection has a broad spectrum of disease, including Dengue Shock Syndrome.
• Hemodynamic collapse happens at the conclusion of febrile phase.
• If stable for outpatient management, will need PLT count and HCT daily.
• For non-cardiogenic pulmonary edema, remember NOT CARDIAC.