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SALICYLIC ACID Made by Dr. Amna Rao Presented by Sobia Hussain Roll # 80 SALICYLIC ACID • An odorless, crystalline solid substance. • Has a sweetish taste. • Used externally for treatment of skin diseases. • It has a remote action after absorption. • Causes marked irritation of gastric mucous membrane. • Important preparations: • Sodium salicylate and methyl salicylate (oil of winter green) are important prepations of salicylic acid. • Natural forms: • Salicin and methyl salicylate are naturally occuring forms, found in leaves and bark of a number of plants (willow tree). FATAL DOSE • Salicylic Acid: 70-80 grams. • Sodium Salicylate and Acetyl Salicylic Acid: 15-20 grams. • Methyl Salicylate: 10-20 ml. FATAL PERIOD • Salicylic Acid: 4-7 days • Sodium Salicylate: 1-3 days • Methyl Salicylate: 12-24 hours. CLINICAL FEATURES: • In Therapeutic Doses, aspirin is absorbed • • rapidly from small intestine and stomach walls. In Overdose absorption may occur more slowly and plasma salicylate concentration may rise up to 24 hours. Salicylates stimulate respiratory centers in medulla & increase rate and depth of respiration. CO2 is eliminated from the lungs causing respiratory alkalosis. • Dehydration and hypokalaemia results due • • • • • to excess sodium, potassium and water excreted in urine. Metabolic Acidosis develops because of interference with lipid, protein, carbohydrate and amino acid metabolism by salicylate ions. Primary toxic effect of salicylate overdose is hyperpyrexia, sweating, fluid loss, nausea and vomiting. CNS: acidaemia, tremors, delirium, convulsions, stupor and coma; so called salicylate jag. Renal Involvement: maybe shown by proteinuria, sodium and water retention and tubular necrosis. Tinnitus: deafness and increased labyrinthine pressure occurs. Coma occurs in terminal stages. MANAGEMENT • Stomach wash. • Gastric lavage with sodium bicarbonate • • • • • solution. Activated charcoal suspension can be used. Forced alkaline diuresis can be helpful in eliminating aspirin and other salicylates from the body. Sodium Bicarbonate in the dose of 1-2 meq/kg can be given intravenously. IV fluids to correct electrolyte imbalance. Vitamin K can be given in case of severe hypoprothrombinaemia. POSTMORTEM APPEARENCE: • These include evidence of: • Hemorrhagic gastritis • Subpleural and subpericardial hemorrhages • Pulmonary and cerebral edema • Renal irritation • Congestion of viscera MEDICOLEGAL ASPECTS: • Accidental Poisoning common in children. In • • • adults cause hypersensitivity reactions. Suicidal poisoning uncommon. In neotaes, infants and children salicylate intoxication may occur through placental transfer, breast milk or by application of teething gel to the gums. United states studies have suggested an association between Reye syndrome and use of salicylates. Salicylates should not be used in children under 12 years indicated for Childhood Rheumatic Condition. • Aspirin Hypersensitivity: • Increase salicylate levels. • Fatal hypersensitivity reaction occurs within minutes of ingestion. • Causes vasomotor rhinitis, angioneurotic edema and utricaria. • Laryngeal edema results in death. • Treatment involves immediate administration of adrenaline (s/c) and corticosteroids. •THANK YOU!!!