Emergency Simulation Case: Aspirin Overdose

A 65 year old male complains of nausea, vomiting, abdominal pain.

HPI: ringing ears, dizziness over 2 days.

PMHx: Osteoarthritis

Meds: Bayer aspirin, no known drug allergies (NKDA)

Social Hx: 

• Alcohol in recent past
• Quit smoking
• Denies drug use
• No travel hx
• No new foods
• No thoughts/attempts of suicide

Physical:

• HR: 129
• BP: 111/66
• SpO2: 98
• Temp: 38.1 C
• Dry mucous membranes
• Ok turgor
• Breathing worsening
• No peripheral edema
• Took 2 Bayer pills every 2-3 hours over the past few days

Labs Ordered:

• Bolus normal saline
• Chem 7
• CBC
• Amylase
• Lipase
• Urinalysis
• Toxicology
• ABG
• Chest and abdominal X-ray

Results:

• High lymphocytes 55%
• High fever
• Salicylate level: 141
• Clear chest/abdominal x-ray

DDx: 

• salicylate overdose
• respiratory alkalosis
• issues spleen
• duodenal ulcers
• kidney

Assessment & Plan: 

• Gave fluids and sodium bicarb
• Repeat salicylate levels
• Chest & abdominal xray
• Dialysis

Take Home Points:

• Look at likelihood ratios from tests that will point you in certain directions when making a diagnosis.
• WBC could be a stress response, a way to rule out infection.

Live Blog: Blood Glucose

Today's didactic was on blood glucose monitoring in Type II diabetes presented by Jennifer Allen, PharmD here at Healthcare Associates.

What it Does:

• Helps patients to assess diet and exercise habits
• Guides changes in medication therapy
• Provides tool to confirm signs and symptoms of hypo/hyperglycemia

When to Start Using:

• Right at diagnosis
• Helpful guide for those with blood sugar little high
• When initiating meds that potentially cause hypoglycemia
• Any symptoms supported with hypoglycemia

Goals of Therapy:

• Educate patients on what the numbers mean
• Aim for fasting blood sugar of 70-130
• 2 hours after meals >180
• Goals should be individualized 
• Duration of disease
• Life expectancy
• Co-morbidities
• Hypoglycemia unawareness

When to Test:

• With oral meds only: once a day
• Start with checking fasting sugar and getting that down to goal
• Next work on getting post-prandial readings down
• With basal insulin +/- oral meds:
• Min once daily before breakfast
• Occasional 2 hr post-prandial readings helpful
• Use a blood glucose log to track progress

Technique:

• Wash hands
• Insert new test strip and insert lancet into device
• Press lancing device firmly to side of finger
• Press actuation button to fire needle
• Apply blood sample to tip to test strip
• Await result and log numbers

Patient Counseling Points:

• Take blood glucose more regularly
• Drink water
• Consult your doctor on symptoms
• Make sure test strips are insured
• Recommended machines: 
• Onetouch Ultra 2
• Freestyle Freedom Lite (portable)