Refractory hypoglycemia secondary to topical salicylate intoxication

Article Abstract:

Lotions containing salicylate are used to treat certain skin disorders, despite the fact that the drug can be absorbed through the skin and has been associated with life-threatening complications. A 72-year-old man was admitted to a hospital in a state of confusion, with nausea and weakness. He had been applying a salicylate cream to approximately 80 percent of his body three times a day for 3 to 4 weeks to treat psoriasis. He had a history of end-stage kidney disease, and was thought to be suffering from uremic encephalopathy (an altered mental state due to increased blood levels of urea, a toxic compound normally excreted by the kidney). He was started on dialysis, but his mental status did not improve. He was found to be hypoglycemic (to have low blood sugar), and was given fruit juices and intravenous infusions of glucose (sugar), but his glucose level did not increase and he remained confused and lethargic. The hospital staff had continued to apply the salicylate cream to his skin, but this treatment was discontinued, and he was put back on dialysis. After six hours, the patient's hypoglycemia and confusion resolved. Salicylate seems to cause hypoglycemia by increasing the body's metabolism of glucose while inhibiting the formation of glucose from amino acids. (In other words, glucose is used up, but not replaced.) There was no other explanation to account for this patient's hypoglycemia. Altered mental state is a common feature of salicylate toxicity when the drug is taken orally (as aspirin), but this appears to be the first case of altered mental state and hypoglycemia due to salicylate absorbed through the skin. The presence of skin lesions increases the absorption of the drug. Physicians who employ salicylate creams to treat skin lesions should be aware of this possible life-threatening complication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Psoriasis, Dermatologic agents, Hypoglycemia, Salicylates

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Hypokalemia after theophylline intoxication: the effects of acute vs chronic poisoning

Article Abstract:

Theophylline is a chemical similar to caffeine that is used to relax smooth muscle and as a diuretic to rid the body of excess fluid. Theophylline intoxication from overdose can cause a variety of complications, including hypokalemia, a decreased amount of potassium in the blood. Hypokalemia can cause irregular heart beats. Some studies indicate physiological differences between the hypokalemia produced by sudden (acute) theophylline intoxication and that created by long-term (chronic) theophylline overdoses. To describe the pattern of hypokalemia produced by theophylline intoxication, 88 patients with a blood level of greater than 0.165 mmol/liter (mmol/L) of theophylline had their blood potassium levels measured. Initial potassium levels ranged between 2.20 to 5.80 mmol/L. Patients identified as hypokalemic, 60 percent, were assessed as having chronic or acute intoxication. Of patients with acute theophylline intoxication, 85 percent were hypokalemic. Of the patients classified with chronic intoxication, 32 percent were hypokalemic. Patients with chronic and acute episodes of theophylline intoxication produced different levels of hypokalemia. The reasons for the different potassium levels found in these two groups and the consequences of hypokalemia are not explained.

Theophylline, Hypokalemia

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Prevalence of Alcohol Problems among Pediatric Residents

Article Abstract:

Many residents are at risk for alcohol abuse. Of 81 pediatric residents who took the Michigan Alcoholism Screening Test, 22% had scores indicating they had problems with alcohol. Thirty-five percent admitted drinking so heavily they blacked out but only 1 resident had sought help for the problem. None of the residents believed their drinking affected their job performance.

Statistical Data Included, Surveys, Drinking of alcoholic beverages, Drinking (Alcoholic beverages), Residents (Medicine), Alcohol use

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