SALICYLATE OVERLOAD: A CASE OF CHRONIC SALICYLATE POISONING Nikki Arceneaux, Pooja Goel, Charlie Woodall, Seth Vignes; Louisiana State University, New Orleans, LA.
Introduction: Chronic salicylate toxicity results from the prolonged ingestion of salicylate-containing compounds, most notably aspirin or in this specific case BC powder. Salicylates are widely used over- the-counter medications known for their analgesic and anti-inflammatory properties. Salicylates can be therapeutic at appropriate doses, but chronic exposure or overdoses can lead to significant toxicity. Case: A 71-year-old woman with hypertension, hyperlipidemia, spinal stenosis, and arthritis presented reporting slurred speech and altered mental status upon waking up. Upon further questioning, she reported feeling unwell for the past three weeks consisting of intermittent sinus pressure, gait imbalance, and difficulty hearing. She reported taking 10-15 BC packets a day for the past week for her joint pain. Upon physical examination, the patient had noticeable dysarthria, ataxia, and tachypnea. Labs were notable for a salicylate level of 68 mg/dL. Arterial blood gas showed a pH 7.42, pCO2 of 18 mmHg, and HCO3 of 11.4 me/L, indicative of chronic respiratory alkalosis. Her comprehensive metabolic panel indicated a non- anion gap metabolic acidosis from compensation with slight anion gap metabolic acidosis. Poison
control advised starting a sodium bicarbonate drip. Despite her initial improvement, she became more somnolent and disoriented. Emergent dialysis led to rapid improvement in her mentation and salicylate levels. Frequent monitoring allowed cessation of the bicarbonate drip as salicylate levels normalized. Her hearing, speech, and gait improved significantly and was discharged to a skilled nursing facility for rehabilitation with a scheduled outpatient follow-up. Discussion: Chronic salicylate toxicity compared to acute salicylate toxicity, results from repeated overmedication that occurs across several days and has a gradual onset of symptoms. The classic triad for salicylate toxicity is hyperventilation, tinnitus and gastrointestinal upset, but can include nausea, vomiting, agitation, slurred speech, coma, and seizures. Urinary alkalinization is a key element in the management of both acute and chronic salicylate toxicity. This case underscores the importance of prompt diagnosis of salicylate toxicity. Healthcare providers should be aware of the potential risks of over-the-counter analgesics and educate patients about safe medication practices and the importance of adherence to recommended dosages to mitigate the risk of toxicity
STEPPING INTO TROUBLE: A CASE OF PSEUDOMONAS MENDOCINA BACTEREMIA Nikki Arceneaux, Alexa Lapointe, Blane Edwards, Sanjay Kamboj; Louisiana State University, New Orleans, LA.
Introduction: Pseudomonas mendocina is a gram- negative, aerobic, rod-shaped bacterium belonging to the Pseudomonas genus. Even though it is thought to cause infections quite rarely in humans, it can cause severe infections even in immunocompetent individuals. In review of current literature, this case describes the twenty-third documented report of P. mendocina and the fourth documented case of P. mendocina bacteremia in the United States. Case: A 68-year-old female with a history of elephantiasis nostras verrucosa, morbid obesity, insulin-dependent diabetes mellitus, and hypertension who presented with altered mental status after being found unresponsive for an unknown period by her family and the fire
department. Upon arrival to the hospital, she was tachycardic and febrile, with a temperature of 101°F. Her physical exam revealed an intubated and sedated patient with bilateral lower extremity edema, bilateral heel ulcers, numerous verrucous- like lesions with sanguineous drainage, and an odor emanating from the wounds. Pertinent laboratory findings included a C-reactive protein level of 457 mg/L, procalcitonin of 15.46 ng/mL, and a white blood cell count of 24.91 x 10³/µL. Blood cultures were collected, and the patient was started on broad spectrum antibiotics. A computed tomography scan of the head, chest, and abdomen were unrevealing for an infectious source. Both sets of blood cultures obtained on the day of admission were positive for gram-negative rods, found to be Pseudomonas 49
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