EXPERIMENTAL SALICYLATE POISONING: OBSERVATIONS ON THE EFFECTS OF CARBONIC ANHYDRASE INHIBITOR AND BICARBONATE

[摘要] In a series of experiments on dogs it has been shown that injection of the carbonic anhydrase inhibitor acetazoleamide (Diamox®) is followed by an increase in the renal excretion of salicylate. However, the increased excretion of salicylate is achieved only at the expense of paralyzing the powers of the kidney to deal with metabolic acidosis. As a result, administration of acetazoleamide increases the mortality of animals which have received large doses of salicylate. It is therefore strongly recommended that acetazoleamide not be used in the treatment of patients poisoned with salicylate.On the other hand our animal experiments suggest that administration of sodium bicarbonate to patients with salicylate poisoning is not harmful even when given early in the course of the development of symptoms. As a result, we have been administering amounts of bicarbonate calculated to raise the concentration of bicarbonate in the plasma by 5 to 10 mEq/l, repeated not more than once every 12 hours.The mechanism of production of acidosis in salicylate poisoning is discussed in the light of present knowledge of the inhibitory effects of salicylates on certain steps of intermediary metabolism of carbohydrates and fats. The means by which acidification of the urine (in an attempt to compensate for the existing metabolic acidosis) further impairs the excretion of salicylates is also discussed.

[学科分类] 儿科学