![]() Obtain levels q1-2hr until levels decline and patient's clinical status stabilizes.Only other entity that produces this pattern is sepsis.Respiratory alkalosis (earliest sign), AG metabolic acidosis, metabolic (contraction) alkalosis.Urinary alkalinization inhibited by excretion of H+ in order to reabsorb K+.Hypokalemia requires aggressive repletion - this differentiates from DKA which tends to have hyperkalemia or normokalemia at initial presentation.Hyperglycemia in periphery (CSF will have low glucose due to CNS hypermetabolic state).Acetaminophen level (possible co-ingestant).Propylene glycol infusions for lorazepam and phenobarbital.Sepsis, shock, liver disease, CO, CN, metformin, methemoglobin.Higher morbidity ( pulmonary edema, seizures, renal failure) and mortality rate compared with acute toxicityÄifferential Diagnosis Anion gap metabolic acidosis.Usually neurologic abnormalities, especially in elderly.Due to inhibition of prostaglandin synthesis, can lead to premature closure of the ductus arteriosus.There can be displacement of bilirubin from protein binding sites allowing it to cross the blood brain barrier, which can lead to kernicterus.Due to fetal inability to hyperventilate leads to worsening acidosis.Un-ionized salicylate cross the placenta due to higher fetal pH, where it becomes ionized and accumulates in the fetus.Increased fetal morbidity and mortality. ![]()
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