Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion

Abstract

OPEN ACCESSSeptember 26, 2014Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion Jennifer Mitzman, MD, Mary Wittler, MD Jennifer Mitzman, MD Wake Forest School of Medicine of Wake Forest Baptist Medical Center Google Scholar More articles by this author , Mary Wittler, MD Wake Forest School of Medicine of Wake Forest Baptist Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9893 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This educational resource provides information and materials for a simulation case suitable for resident physicians in emergency medicine. The scenario has been used at our institution for the past year. Participants have included medical students, emergency medicine and general pediatrics residents in years 1-3 of postgraduate education, and pediatric emergency medicine fellows in years 4-6 of postgraduate education. Methods: This simulation involves a patient presenting to an emergency department with an anion gap metabolic acidosis secondary to acute salicylate ingestion. Evaluation in the emergency department reveals a tachycardic, tachypneic patient who requires aggressive fluid resuscitation. The patient also requires alkalinization with bicarbonate to halt the progression of the acidosis. Ultimately, levels obtained should prompt learners to admit the patient to the intensive care unit for dialysis. The case has been used with small groups of two to four learners in each session. Debriefing materials are provided to illustrate key concepts in recognition of anion gap metabolic acidosis and to stimulate discussion of the important treatment steps in acute salicylate ingestion. Typical timing for the case is approximately 20 minutes for the simulation and 20 minutes for debriefing. Results: Testing of this scenario has been accomplished via repetition with various learners. While this educational case has been used for simulation sessions as part of the didactic component of our residency and fellowship, it has not been validated as a formal assessments tool for evaluation of clinical competency. Discussion: Implementation of this case requires significant resources: a high-fidelity patient simulator, appropriate environment, medical equipment, and personnel to provide the educational experience for learners. The case requires one faculty or staff member capable of running the simulator and one faculty member with the required clinical expertise to facilitate the case and conduct the debriefing and educational session. We have used this case primarily for resident physician education in pediatrics and emergency medicine, as well as for fellows in pediatric emergency medicine. Medical students have participated at times in supporting provider roles but not as team leaders given the degree of difficulty of this case. Educational Objectives By the end of this simulation, learners will be able to: Demonstrate recognition of acute salicylate toxicity.Identify the need for fluid resuscitation.Interpret arterial blood gas and recognize acid-base disturbance.Understand the need to begin alkalinization and initiate bicarbonate. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide Aspirin Case.docx Simulation Template Acute Salicylate Ingestion.docx Appendix A Aspirin Case Labs and Imaging.ppt Appendix B Aspirin Debriefing Tool.pptx Appendix C Aspirin Case Evaluation Form.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationMitzman J, Wittler M. Toxic Ingestion: Anion Gap Metabolic Acidosis Caused by Acute Salicylate Ingestion. MedEdPORTAL. 2014;10:9893. https://doi.org/10.15766/mep_2374-8265.9893 Copyright & Permissions© 2014 Mitzman and Wittler. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsEatingAcute PoisoningEditor's ChoiceSalicylatesIngestion Disclosures None to report. Funding/Support None to report. Loading ...