Salicylate poisoning
Intoxicación por salicilatos
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=> "Ruiz-Zorrilla López" "email" => array:1 [ 0 => "carlosruizzorrilla@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Belén" "apellidos" => "Gómez-Giralda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Antonio" "apellidos" => "Molina-Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Sección de Nefrología, Hospital Universitario Río Hortega, Valladolid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intoxicación por salicilatos" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor,</span></p><p class="elsevierStylePara">We would like to clarify a few points with regard to the letter on salicylate poisoning published in this issue of Nefrología<span class="elsevierStyleItalic">.</span></p><p class="elsevierStylePara">Firstly, we would like to thank Drs Nogué and Dueñas for their recommendations, which appear to be extremely useful for the management of such cases of poisoning.</p><p class="elsevierStylePara">They are correct in doubting that we started urine acidification treatment because the text later goes on to state that urine alkalinisation treatment was required. The purpose of urine alkalinisation treatment is to increase urinary pH in order to decrease reabsorption of salicylates by the proximal convoluted tubule. In fact, it increases excretion of metabolites by 10 to 20 times with respect to patients who do not receive this treatment.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Regarding the administration of activated charcoal and gastric lavage, both treatments have been shown to decrease absorption of the toxin, and their use depends on the time elapsed between ingestion and receiving medical care. It has been proven that combined therapy produces better results than monotherapy,<span class="elsevierStyleSup">1</span> and therefore numerous guidelines recommend concomitant administration. Gastric lavage is a very useful technique in this type of situation, mainly in the first hour after ingestion of the toxin, although it may be indicated during the first 8 to 12 hours if the salicylate tablets have enteric coating, as was true in our case. As for activated charcoal, its action lasts for the first 2 to 4 hours after ingestion,<span class="elsevierStyleSup">2,3</span> and it is currently a key treatment for most types of poisoning as Drs Nogué and Dueñas state. In our clinical case, gastric lavage was performed; activated charcoal was not administered since more than 4 hours had elapsed between ingestion and assessment of the patient by the emergency department, and it would not have been very effective.</p><p class="elsevierStylePara">After examination, the patient was prescribed urine alkalinisation, gastric lavage and saline to correct hydroelectrolytic alterations, and admitted to the intensive care unit. After 5 hours, despite receiving treatment, the patient experienced decreased cognitive state, hypotension and oliguric renal failure, and we then decided to start haemodialysis treatment. Extra-corporeal therapy was indicated because of the patient’s poor clinical evolution (worsening neurological state, sustained hypotension despite saline administration and acute oliguric kidney failure), and not because of the serum salicylate level.<span class="elsevierStyleSup">1-3</span> The literature describes numerous cases in which levels below 100mg/dl have proven fatal for the patient, and many articles recommend the use of haemodialysis for rapid correction of the acid-base disorder and hydroelectrolytic imbalance in such cases.<span class="elsevierStyleSup">4,5</span> However, it is true that there are no studies comparing conservative treatment and use of dialysis. In our opinion, a nephrologist should be consulted in cases of salicylate poisoning in order to evaluate the option of haemodialysis, particularly in cases with poor clinical evolution.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article.</p>" "pdfFichero" => "P1-E534-S3461-A11343-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dargan PI, Wallace CI, Jones AL. An evidence based flowchart to guide the Management of acute Salicylate (aspirin) overdose. Emerg Med J 2002;19:206-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11971828" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jiménez Murillo L, Montero Pérez FJ, et al. Intoxicación aguda por salicatos y otros AINE.\u{A0} En: Jiménez Murillo L, Montero Pérez FJ (eds.). Compendio de Medicina de Urgencias: Guía terapéutica. Cap. 131. Madrid: Elsevier España; 2006. p. 430-3." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García Sánchez JI, Llenas García J, Melgar Molero V. Intoxicaciones. En: Cardavilla Martínez AB, Castelbón Fernández FJ, García Sánchez JI, Gracia Lorenzo V, Ibero Esparza C, Lalueza Blanco A, et al. Manual de Diagnóstico y Terapéutica Médica. 6.ª ed. Cap. 80. Madrid: Hospital Universitario 12 de octubre; 2007. p. 1097-121." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fertel BS, Nelson LS, Goldfarb DS. The underutilization of hemodialysis in patients with salicylate poisoning. Kidney Int 2009;75:1349-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18716600" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "McGuigan MA. A two-year review of salicylate deaths in Ontario. Arch Intern Med 1987;147:510-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3827428" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000002/v0_201502091616/X2013251412000777/v0_201502091617/en/main.assets" "Apartado" => array:4 [ "identificador" => "35439" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Comments on published articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000002/v0_201502091616/X2013251412000777/v0_201502091617/en/P1-E534-S3461-A11343-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000777?idApp=UINPBA000064" ]
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