Group 8 (36-40);

Faisal FarooqFareeha GulFatima AlamSyed Hassaan MasroorEman Afroze

Instructor: Dr. Hira

By;Fatima AlamSyed Hassan

Masroor Group: 8 (36-40)

BLOODTESTS

ABG-TEST(Arterial

Blood Gas Test)

Serum Salicylate Level Test

Faisal FarooqFareeha Gul

Presenters of Group 8 (36-40)

Chemically “ Acetylsalicylic acid” [ASA].

A part of a drug family known as NSAIDs or non-steroidal anti-inflammatory drugs.

Uses Of ASPIRIN analgesic (Pain Killer) Anti-pyretic (Anti-fever)

Anti-inflammatory drug

For Cardio-Vascular Diseases (prevents blood clot formation)

Mode Of Action Of ASPIRIN

AD Acid

serine

COXProstaglandins

free nerve endings

CNS

Damaged cells release arachidonic acid

PAIN

Normal Pain Sensation Mechanism

Aspirin Aspiri

n

Damaged cells release arachidonic acid

AD Acid

serine

COX

Acetyl-

Prostaglandins

PAIN

In the presence of ASPIRIN

What’s the need to inhibit synthesis of “prostaglandins”….?Actions of PROSTAGLANDINS Actions Of ASPIRIN

1. Sensitize spinal nerves to pain. 2. Regulate inflammatory mediation.

3. Act on thermoregulation centers in hypothalamus to produce fever. 4. Act on glomerular cells to increase filtration rate.

5. Act on parietal cells in stomach to inhibit acid secretion.

Removes PAIN

Removes INFLAMMATIONPrevents FEVER

Decrease filtration rate, can cause Renal InsufficiencyMore ACID secretion,can cause GI-ToxicityThromboxane causes platelet aggregation. Aspirin prevents blood clot formation by

inhibiting thromboxane synthesis. Therefore ASPIRIN is used by cardiac patients to prevent heart attack. These patients have a slogan “An Aspirin A Day, Keeps The Doctor Away”.

Aspirin toxicity or SALICYLISM is acute or chronic poisoning with overdose of aspirin.

o10-30 mg/d L: Therapeutic level (No Poisoning)o>30 mg/d L : 1st Sign of toxicityo if >100mg/d L: Early hemodialysis should be considered

•Uncoated tabs (therapeutic doses): 15-20 mins.• Enteric coated tabs: 18-24 hours

Salicylate Levels

Absorption

Aspirin Toxicity

CAUSES 0f Toxicity

Accidental

Intentional

Accidental ingestion by pre-school children or elderly

1. Suicidal Attempt by adults or teenagers.

2. Therapeutically acquired intoxication.

August 12, 1977

Theodore Hirschberg vs. State Of NY

New York Court Of Claims

•No doctors available

psychiatrist•Examination revealed toxicity symptomology but doctor couldn't diagnose.•No diagnostic tests done. •Transfer advice.

•No physical examination.•No test.•Physician thought his colleague had seen the patient.•Gave patient anti-psychotic and put him on suicide alert.•Later investigations revealed that the doctor was not licensed.

$ 35,000/-•Suicide Attempt….why?•Because the person faces hallucinations/convulsions.

Symotomology does reveal;FEVER, TINNITUS, NAUSEA, TACHYPNEA etc.

Tinnitus

Tachypnea

Nausea/VomitingAbdominal Pain

•Electrolyte Abnormalities

•Metabolic Acidosis

• Respiratory Alkalosis

•AMS (Altered mental status)•Cerebral edemaPulmonary edema

Renal Failure

•Hyperthermia

•Convulsions/Hallucinations

• Seizures• Coma

SYMPTOMS

Common Severe

Ataxia

Salicylates inhibit Krebs Cycle and

uncouple oxidative

phosphorylation

Glucose cannot be metabolized,Decreased ATP concentration

Cellular metabolic activity increases

to synthesize more ATPs

Increased uptake of GLUCOSE from plasma by cells

Hypoglycemia

Formation of KETONE BODIES

as alternate energy source

AMS(Altered Mental Status)

Metabolic

Acidosis

Results in respiratory alkalosis as

compensation for metabolic acidosis

Biochemistry

Pathology

SYMPTOMS

Mild Toxicity

< 150 mg/kg

Moderate Toxicity150-300 mg/kg

Severe Toxicity

>300 mg/kg

Nausea/Vomiting

Confusion AMS ( Altered mental status )

Tinnitus Tachypnea Respiratory arrestHearing Loss Hyperpyrexia Renal failure

Dizziness Diaphoresis Arrhythmia Ataxia Shock

Anxiety SeizuresComa

AmountIngeste

d

ToxicityLevel

Diagnosis

Physical Examination

ABG Test[Arterial Blood Gas Test]

SerumSalicylateLevels

Fever

Tinnitus

Tachypnea

N/V

Abdominal Pain

>30 mg/d L,toxicity is present

Respiratory Alkalosis