[Analysis of the intoxicated patient: pitfalls].
A 39-year-old man was admitted to the ICU after having taken 96 tablets of 500 mg acetylsalicylic acid. Although a high plasma concentration (1040 mg/l) was found, underestimation and misinterpretation of clinical signs and symptoms with decreasing salicylate plasma concentrations led to haemodialysis being postponed. One day after admission the patient suddenly died of cardiovascular collapse due to severe salicylate toxicity. Doctors should be aware that underestimating the severity of salicylate intoxication is a common and dangerous pitfall. Another patient, a 60-year-old woman, was suspected of suffering from toxic alcohol intoxication. She had marked hyperlactaemia (17 mmol/l), which could not be explained from a clinical perspective. However, ethanol was administered intravenously while awaiting the toxic alcohol test results (ethylene glycol: 1300 mg/l). The hyperlactaemia was artificial and caused by an interaction between glycolic acid and lactate on a point-of-care analyser. Doctors should consider artificial hyperlactaemia in patients with ethylene glycol intoxication. The patient recovered.
de Bree
Godelieve J
GJ
Tergooiziekenhuizen, Afd. Intensive Care, Hilversum, The Netherlands.
Butterhoff-Terlingen
Madelon H
MH
Vermeer
Eric H J
EH
Treskes
Marco
M
van der Linden
Paul D
PD
Ruys
Thomas A
TA
D000328:Adult; D000435:Alcoholic Intoxication / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D001241:Aspirin / Q000008:administration & dosage* / Q000506:poisoning*; D003937:Diagnosis, Differential; D000431:Ethanol / Q000506:poisoning; D005260:Female; D006801:Humans; D008297:Male; D011041:Poisoning / Q000175:diagnosis* / Q000628:therapy*; D006435:Renal Dialysis; D016896:Treatment Outcome
D000431:Ethanol; D001241:Aspirin