Delayed salicylate toxicity at 35 hours without early manifestations following a single salicylate ingestion

OBJECTIVE: To report a case of delayed toxicity following a single ingestion of aspirin, where the initial concentrations were nearly undetectable and the patient was completely asymptomatic for the first 35 hours. CASE SUMMARY: A 14-year-old white female was evaluated after a single ingestion of 120 tablets of aspirin 81 mg/tablet hours before arrival to the emergency department. She denied nausea, abdominal pain, tinnitus, or shortness of breath. She received one dose of activated charcoal. The first salicylate concentration (4 h after ingestion) was 1 mg/dL. At 35 hours, the patient became symptomatic (dizziness, tinnitus, epigastric discomfort). Her salicylate concentration at that time was 46 mg/dL. A second dose of activated charcoal was administered, and intravenous bicarbonate with potassium was started as a continuous infusion for 30 hours. DISCUSSION: While delayed salicylate toxicity is well reported in the literature, no report was found regarding concentrations increasing to toxicity 35 hours after ingestion. The delayed aspirin absorption may be due to salicylate-induced pylorospasm or the formation of pharmacobezoars. CONCLUSIONS: In cases with known salicylate ingestion, it is important to follow salicylate concentrations every 4 hours until they are steadily decreasing according to a 4-hour half-life and the patient shows no symptoms of salicylate intoxication.     

The clinical laboratory manifestations of severe form of diffuse toxic goiter

The article deals with nowadays considerations concerning the pathogenesis of such systemic autoimmune disease as diffuse toxic goiter. The clinical monitoring of severe form of diffuse toxic goiter complicated by systemic autoimmune manifestations with characteristic alterations of results of clinical, biochemical, hormonal and immunologic analyses is analyzed.     

The effect of sodium salicylate on antibiotic susceptibility and synergy in Klebsiella pneumoniae

Sodium salicylate was combined with the antibiotics amikacin, aztreonam, cefazolin, cefonicid, cefoperazone, ceftizoxime, norfloxacin, doxycycline, clindamycin, imipenem, mezlocillin and trimethoprim-sulphamethoxazole. The activity of the combinations was tested against encapsulated strains of Klebsiella pneumoniae, which differed markedly in their antibiotic susceptibility. The addition of salicylate (from 2 to 350 mg/l) to cultures increased the MIC of most antimicrobial agents from two- to four-fold, with the exception of imipenem and amikacin. Inhibition by imipenem was largely unchanged, and that of amikacin was increased in the presence of salicylate. The synergy of the combination of cefazolin and amikacin was abolished by salicylate, while the synergistic activity of imipenem and amikacin was significantly increased by salicylate. Doxycycline activity was most severely affected by salicylate as antimicrobial activity was significantly diminished at salicylate levels as low as 5 mg/l. In contrast, significant loss of inhibitory activity with other antimicrobials required at least 100 mg/l of salicylate. The clinical implications of salicylate on the sensitivity of K. pneumoniae to antimicrobials are discussed.     

Treatment of plantar verrucae using 2% sodium salicylate iontophoresis

BACKGROUND AND PURPOSE: Iontophoretic sodium salicylate treatment of plantar warts was studied. SUBJECTS: Twenty patients with 104 plantar verrucae were studied. METHODS: Two percent sodium salicylate solution was administered iontophoretically (22.5 mA-minute/electrode, 3 treatments at 6- to 9-day intervals). Results. Nineteen subjects were followed. Verrucae area declined in 15 subjects (78.9%) and increased in 2 subjects (10.5%). One subject (5.3%) no longer had verrucae, and 1 subject (5.3%) exhibited no change. Overall, the number of verrucae and total area decreased. Four of 6 subjects (66.6%) with initial complaints of load-bearing pain reported diminished pain following treatment. Two subjects whose verrucae's size increased reported an increase in pain at the end of the study. DISCUSSION AND CONCLUSION: Sodium salicylate iontophoresis appeared to compare favorably with other office-based interventions in diminishing the size of plantar warts and their associated pain. Application of iontophoresis to weight-bearing surfaces in some subjects appeared to decrease the pain and scarring associated with freezing and electrocautery and the fixation problems associated with medicated patches.     

钠离子紊乱病因及神经系统并发症

钠离子紊乱是临床常见的电解质紊乱,其可导致神经系统并发症;神经系统表现多为功能性改变,如果及时合理纠正,症状通常可逆。相反,如果不恰当处理,则可导致症状加重,出现不可逆性损害,甚至导致患者死亡。因此,有效的识别和治疗钠离子紊乱以及积极处理导致电解质紊乱的原发疾病极为重要。本章主要阐述低钠血症与高钠血症的病因,所致神经系统并发症的相关机制、临床表现及其治疗。     

水杨酸钠诱导PC12细胞凋亡的作用

目的：观察水杨酸钠诱导大鼠肾上腺嗜铬细胞瘤细胞（PC12）凋亡的作用并初步探讨其机制。方法：实验于2004-07／2005—11在武汉大学完成。选择大鼠肾上腺嗜铬细胞瘤细胞（PC12）为观察对象，将PC12细胞培育于培养板，无血清同步化后随机分组。以不同浓度的水杨酸钠（低浓度（0．3125,0．625mmol／L）．高浓度（1．25，2．5，5mmol／L）]处理72h，MTT法检测细胞活力；倒置显微镜和荧光显微镜下观察细胞形态；流式细胞术检测凋亡率；Western blotting检测胞内NF—κB 的含量。结果：水杨酸钠为1．25-5mmol／L时显著减少PC12细胞的存活率（P〈0．01）；并引起典型的凋亡形态学改变：表现为细胞体积明显缩小、变圆，部分细胞从贴壁状态变为悬浮状态，折光性减弱。流式细胞术检测细胞凋亡率，随着水杨酸钠浓度的增加，细胞凋亡率明显升高，较低浓度水杨酸钠（0．3125,0．625mmoL／L）处理组凋亡率与对照组比较升高不明显（P〉0．05）。高浓度水杨酸钠（1．25，2．5，5mmol／L）处理组细胞出现典型凋亡峰，凋亡率较对照组显著增高，差异有显著性（P〈0．01），并且具有浓度依赖性。随着水杨酸钠作用浓度的增加，PC12细胞中NF-κB BP65蛋白表达水平逐渐降低。结论：高浓度的水杨酸钠可以体外诱导PC12细胞凋亡；水杨酸钠可剂量依赖性的减少PC12细胞内的NF-κB B含量。     

水杨酸钠诱导PC12细胞凋亡的作用

目的:观察水杨酸钠诱导大鼠肾上腺嗜铬细胞瘤细胞(PC12)凋亡的作用并初步探讨其机制。方法:实验于2004-07/2005-11在武汉大学完成。选择大鼠肾上腺嗜铬细胞瘤细胞(PC12)为观察对象,将PC12细胞培育于培养板,无血清同步化后随机分组。以不同浓度的水杨酸钠[低浓度(0.3125,0.625mmol/L),高浓度(1.25,2.5,5mmol/L)]处理72h,MTT法检测细胞活力;倒置显微镜和荧光显微镜下观察细胞形态;流式细胞术检测凋亡率;Westernblotting检测胞内NF-κB的含量。结果:水杨酸钠为1.25～5mmol/L时显著减少PC12细胞的存活率(P<0.01);并引起典型的凋亡形态学改变:表现为细胞体积明显缩小、变圆,部分细胞从贴壁状态变为悬浮状态,折光性减弱。流式细胞术检测细胞凋亡率,随着水杨酸钠浓度的增加,细胞凋亡率明显升高,较低浓度水杨酸钠(0.3125,0.625mmol/L)处理组凋亡率与对照组比较升高不明显(P>0.05)。高浓度水杨酸钠(1.25,2.5,5mmol/L)处理组细胞出现典型凋亡峰,凋亡率较对照组显著增高,差异有显著性(P<0.01),并且具有浓度依赖性。随着水杨酸钠作用浓度的增加,PC12细胞中NF-κBP65蛋白表达水平逐渐降低。结论:高浓度的水杨酸钠可以体外诱导PC12细胞凋亡;水杨酸钠可剂量依赖性的减少PC12细胞内的NF-κB含量。     

急性口服甲醇中毒的脑部CT及MRI表现

目的 探讨急性口服甲醇中毒导致脑部损害的CT、MRI特点,以提高对该病的影像诊断水平.方法 40例饮假酒致甲醇中毒的患者,均行头颅CT平扫,其中4例行MRI平扫,回顾性分析CT及MRI表现.结果 40例饮假酒致甲醇中毒的患者13例表现为异常的影像.主要是额顶叶白质、外囊-壳核CT有低密度改变6例,最常见(6/13,46%),MR表现为长或短T1长T2改变.1例(1/13,7%)合并右侧壳核出血.双侧外囊CT表现为密度减低4例(4/13.31%),MR呈长或短T1长T2改变.额叶扣带回、岛叶及皮质下白质区轻度密度减低2例(2/13,15%).临床中毒程度越蓖,CT和MRI显示脑部损害程度越明显.结论 急性口服甲醇中毒的脑部CT及MRI表现为临床判定脑损害有着重要的指导意义,其中MRI较CT更能早期发现脑部损害.