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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, July 2, 2015

Intoxicación por salicilatos

TPR - June 30, 2015
Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Juurlink D et al. Ann Emerg Med 2015 May 8 [Epub ahead of print] 
"This paper, from the Extracorporeal Treatments in Poisoning (ExTRIP) workgroup, reviewed the literature on salicylate toxicity to determine evidence- and consensus-based recommendations on indications for use of extracorporeal treatment (essentially hemodialysis) in these cases. The emphasis, as in the group’s papers on other poisons, is on consensus rather than evidence, since the group has consistently found that the level of evidence for use of hemodialysis in any poisoning is very poor, amounting to — their words, not mine — “just a guess.”
All of the recommendations presented here are rated as 1D — “1” representing a “strong recommendation,” “D” indicating that it is based on a “very low level of evidence.” I won’t even get into the group’s confusing distinction between a “recommendation” and a somewhat weaker “suggestion.”
I’ll just summarize the group’s recommendations for starting hemodialysis in salicylate toxicity:
  • Salicylate level > 100 mg/dL
  • Salicylate level > 90 mg/dL in presence of impaired kidney function*
  • Altered mental status
  • New hypoxemia requiring supplemental oxygen
  • Standard therapy (supportive measures, adequate volume repletion, bicarbonate, etc) fails (for example, rapidly increasing levels despite gastrointestinal decontamination and urinary alkalinization)
*Criteria for impaired kidney function include any of the following:
  • estimated glomerular filtration rate < 45 mL/min per 1.73 m3
  • creatinine > 2 mg/dL in adults or > 1.5 mg/dL in elderly or patients with low muscle mass
  • oliguria/anuria for > 6 hours [NOTE: strangely, the recommendations say little about the importance of correcting volume status]"