lytes and ASA poisoning

 Q: Which of the following electrolyte should be treated aggressively in salicylate poisoning? (select one)

A) Sodium

B) Potassium

C) Chloride

D) Phosphate

E) Calcium

Answer: B

Hypokalemia can be detrimental and a barrier in the treatment of salicylate poisoning. The close relationship of potassium and salicylate was first realized during tuberculosis treatments almost 7 decades ago. 

The mainstay of treatment in salicylate overdose is alkalinization of urine. Hypokalemia leads to absorption of K+ in the distal tubule via exchange at the K+/H+ pump. Absorption of K+ promotes excretion of H+ in urine and hampers the alkalinization of urine. 

Hypokalemia should be repleted aggressively in salicylate toxicity.

#toxicology

#electrolytes

References:

1. HEARD KH, CAMPBELL AH, HURLEY JJ, FERGUSON E. Hypokalaemia complicating sodium para-amino-salicylate therapy for pulmonary tuberculosis. Med J Aust. 1950 Oct 21;2(17):606-12. PMID: 14785411. 

2. ROBIN ED, DAVIS RP, REES SB. Salicylate intoxication with special reference to the development of hypokalemia. Am J Med. 1959 Jun;26(6):869-82. doi: 10.1016/0002-9343(59)90209-8. PMID: 13649713. 

3.  Thongprayoon C, Petnak T, Kaewput W, et al. Hospitalizations for Acute Salicylate Intoxication in the United States. J Clin Med. 2020;9(8):2638. Published 2020 Aug 14. doi:10.3390/jcm9082638