Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial i...
Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial infarction. We report 2 cases of young women with aspirin overdose who exhibited ischemic changes on their ECGs a few hours after the ingestion with spontaneous recovery in a few days. First case, a 29 year old woman, presented to the emergency department 6 hours after ingesting 250 tablets of aspirin (325 mg/T). On examination, the temperature was $36.3^{\circ}C$: blood pressure, 105/72mmHg; Pulse, 111/min and respiratory rate, 24/min. Second case, a 27 year old woman, an hour after ingesting 60 tablets (325mg/T). On examination, the temperature was $36.0^{\circ}C$: blood pressure, 102/72 mmHg; pulse, 89/min and respiratory rate, 25/min. In both cases, ECG after 6 hours of ingestion had sinus tachycardia and developed T wave inversion on the anterior leads in the following ECGs. Their initial serum salicylate levels after 6 hours of ingestion were 71.2 mg/dL and 28.4 mg/dL respectively. These salicylate levels were resolving when these ECGs were observed. The ECG changes resolved in the following days and they were discharged without any further symptoms. Further studies are needed, but for the time being, when dealing with salicylate overdose, transient cardiac depression should be kept in mind to avoid adverse ischemic cardiac events.
Symptoms of aspirin overdose may vary from acid-base disturbance, electrolyte abnormality, non-cardiogenic pulmonary edema, chemical hepatitis, seizure to cardiac toxicity. Cardiac adverse effects from aspirin are uncommon but there are reports of arrhythmia, cardiopulmonary arrest, and myocardial infarction. We report 2 cases of young women with aspirin overdose who exhibited ischemic changes on their ECGs a few hours after the ingestion with spontaneous recovery in a few days. First case, a 29 year old woman, presented to the emergency department 6 hours after ingesting 250 tablets of aspirin (325 mg/T). On examination, the temperature was $36.3^{\circ}C$: blood pressure, 105/72mmHg; Pulse, 111/min and respiratory rate, 24/min. Second case, a 27 year old woman, an hour after ingesting 60 tablets (325mg/T). On examination, the temperature was $36.0^{\circ}C$: blood pressure, 102/72 mmHg; pulse, 89/min and respiratory rate, 25/min. In both cases, ECG after 6 hours of ingestion had sinus tachycardia and developed T wave inversion on the anterior leads in the following ECGs. Their initial serum salicylate levels after 6 hours of ingestion were 71.2 mg/dL and 28.4 mg/dL respectively. These salicylate levels were resolving when these ECGs were observed. The ECG changes resolved in the following days and they were discharged without any further symptoms. Further studies are needed, but for the time being, when dealing with salicylate overdose, transient cardiac depression should be kept in mind to avoid adverse ischemic cardiac events.
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문제 정의
저자들은 아스피린 중독에 의해 발생한 비전형적인 흉통 호소 및 심전도의 허혈성 변화를 보인 2례를 경험하였기에 보고하는 바이다.
대상 데이터
증례 2
27세 여자가 내원 1시간 전 아스피린 368 mg/kg (60 알, 325 mg/알)을 복용하여 내원하였다. 과거력상 특이 병력 없었으며 평소에 복용하는 약물은 없었다.
29세 여자가 내원 6시간 전 아스피린 1533 mg/kg (250 알, 325 mg/알)을 복용하여 내원하였다. 과거력상 특이 병력 없었으며 평소에 복용하는 약물은 없었다.
Mark 등8)은 급성 아스피린 중독 후 내원한 13개월 환아에 대한 증례를 보 고 하였다. 이 환아의 경우 내원 3일째 분당 50회 정도의 동성 서맥을 보였고 심초음파에서 좌심실 기능장애를 발견하였다. 그들은 좌심실 기능장애와 폐부종이 일시적이며 혈중 아스피린 농도가 상대적으로 낮아질 때 발생한다고 하였다.
성능/효과
IB). 내원 6일째 증상 없고 심전도가 정상이 어서 퇴원하였다 (Fig. 1C).
2B). 복용 24시간째 시행한 심전도상 동성 서맥 이외에 다른 소견을 보이지 않았고 내원 4일째 퇴원하였다 (Fig. 2C).
3°C, 호흡수가 분당 20 회였다. 의식은 명료하였으며, 양측 폐의 호흡음은 정상이었고 심장음은 규칙적이며 심잡음은 들리지 않았고, 복부는 부드러웠고, 장음은 정상적으로 잘 들렸으며, 국소적인 압통이나 반발통은 없었다.
일반 혈액 검사는 정상이 었으며 일반 화학 검사상 Na* 140 mEq/L, K+3.0 mEq/L, Cl 108 mEq/L, 총단백질 4.9 g/dL, 알부민 3.2 g/dL였으며 다른 결과 또한 정상범위였다 심장효소검사는 CK 227 U/L, CK-MB 3.2 ng/dL, Troponin-T <0.01 ng/dL, 동맥혈 가스 검사상 pH 7.424, pCO2 30.1 mmHg, pO2 148.1 mmHg, HCOj 19.3 mmol/L base excess -3.9 mmol/L, SpO2 96.7%였 다. 복용 6시간째에 측정한 혈중 살리실레이트는 71.
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