Attempts at resuscitation were unsuccessful and the patient expired. One hour after transfer, his electrocardiogram revealed pulseless electrical activity. Repeat arterial blood gasses are shown in Table 1. He was transferred to the intensive care unit. After two failed intubation attempts, he successfully underwent rapid sequence endotracheal intubation followed by mechanical ventilation with a tidal volume setting of 700 ml, a rate of 16/min and a FiO 2 of 100%. The patient was given 10 mg of intravenous diazepam for sedation, which resulted in worsening of his respiratory distress. His vital signs were blood pressure 140/70 mmHg, heart rate of 120/min, respiratory rate of 32/min, O 2 saturation 92%, and an oral temperature of 100.2 ☏ (37.9 ☌). Two hours later, the patient became diaphoretic, tachypneic, more agitated, and complained of respiratory distress. It was then followed by intravenous hypertonic sodium bicarbonate (8.4%) as a bolus of two ampules (89 mEq approximately 1 mEq/kg), followed by a continuous intravenous infusion of sodium bicarbonate, containing three ampules (134 mEq) of 8.4% sodium bicarbonate in 1 l of 5% dextrose in water (D5W), delivered at a rate of 200 ml/h. Serum toxicology revealed the presence of salicylate, and confirmed the absence of acetaminophen and ethanol.Īctivated charcoal (1 gm/kg orally) was administered. A urine toxicology screen confirmed the absence of barbiturates, opiates, cocaine, as well as tricyclic antidepressants.
Urinalysis showed a pH of 6.1 and 1+ ketones but was otherwise unremarkable. Complete blood counts as well as pancreatic and hepatic enzymes were all within normal limits. Admission serum laboratory values are shown in Table 1. Chest X-ray was normal and electrocardiogram revealed sinus tachycardia at 110/min. The remainder of his physical exam was unremarkable. His pupils were equal, round, and reactive to light, cardiac exam was normal other than tachycardia, and his lungs were clear to auscultation bilaterally. His respiratory rate was 24/min, slightly labored, O 2 saturation 98%, and his oral temperature was 98.6 ☏ (37.0 ☌). His initial blood pressure was 128/70 mmHg with a regular heart rate of 110/min. Upon presentation to the hospital, he was alert and oriented and was slightly agitated.
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