ABSTRACT
Acetylsalicylic acid (ASA) intoxication is potentially lethal. After ingestion, AAS is rapidly transformed into salicylic acid that dissociates into an hydrogen ion plus salicylate. Salicylate is the main form of AAS in the body and produces multiple alterations. Initially, the stimulation of the ventilatory center promotes a respiratory alkalosis. Then, the mitochondrial dysfunction induced by salicylate, will generate a progressive metabolic acidosis due to the accumulation of ketoacids, lactic acid and dicarboxylic acids among others. Another alterations include hydro electrolytic disorders, gastrointestinal lesions, neurological involvement, ototoxicity and coagulopathy. The correct handling of acetylsalicylic acid intoxication requires an thorough knowledge of its pharmacokinetics and pharmacodynamics. Treatment consists in life support measures, gastric lavage, activated charcoal and urinary alkalization to promote the excretion of salicylates. In some occasions, it will be necessary to start renal replacement therapy as soon as possible.
Subject(s)
Humans , Aspirin/poisoning , Aspirin/metabolism , Fibrinolytic Agents/poisoning , Fibrinolytic Agents/metabolism , Drug Overdose/physiopathology , Drug Overdose/therapy , Acidosis/chemically induced , Water-Electrolyte Balance/drug effects , Aspirin/administration & dosage , Drug Overdose/metabolism , Hypoglycemia/chemically induced , Hypotension/chemically induced , Mitochondria/drug effectsABSTRACT
Objetivo: Revisar el manejo terapéutico, según el tipo de lesiones, ubicación de acuerdo a la clasificación de Strasberg's Bismuth, y según el momento en que se realiza el diagnóstico. Métodos: Se presentan 5 casos con lesiones iatrogénicas de la vía biliar, en un total de 411 colecistectomías en el Hospital José María Benítez, desde enero 2008 a octubre 2013, en las cuales se realizó tratamiento quirúrgico y/o endoscópico según el caso. Estudio descriptivo y retrospectivo. Resultados: De los 5 pacientes, presentados 4 pertenecen al Hospital José María Benítez y uno fue referido de otro centro asistencial, total de 411 colecistectomías, abiertas 310, laparoscópicas 101. La incidencia en colecistectomía abierta 0,97% (3/309) y en colecistectomía por laparoscopia 0,99% (1/101). La resolución se realizó en 4 casos con tratamiento quirúrgico y en 1 caso con tratamiento endoscópico, esfinterotomía más stent biliar. Evolución post-operatoria sin complicaciones. Conclusión: Las lesiones iatrogénicas de la vía biliar principal son situaciones clínicas complejas con importante morbilidad,generando complicaciones agudas o crónicas afectando severa-mente la calidad de vida en el mejor de los casos, en su gran mayoría se producen durante colecistectomías y se considera que son el resultado de una identificación incorrecta de los elementos del triángulo de Calot. Una vez que se presentan se requiere de un abordaje integral y de un equipo entrenado multidisciplinario entre cirujanos, radiólogos, y endoscopistas(AU)
Objective: To review the therapeutic, depending on the typeof injury management, location according to the classification of Strasberg's - Bismuth, and according to the moment in which the diagnosis is made. Methods: Five cases with iatrogenic injuries of the biliary tract, of 411 cholecystectomies in the Hospital José María Benítez since January 2008 to October 2013, which was carried out surgical or endoscopic treatment according to the case are presented. It's a descriptive and retrospective study.Results: Of the 5 patients presented, 4 belong to the Hospital José María Benítez and one was referred to other healthcare, total 411 cholecystectomies: open 310, laparoscopic 101. The incidence in open cholecystectomy 0.97% (3/309) and laparoscopic 0.99% (1/101). The resolution was carried out in 4 cases with surgical treatment and in 1 case with endoscopic treatment, sphincterotomy plus biliary stent. Postoperative evolution was without complications. Conclusion: The main bile duct iatrogenic injuries are complex clinical situations with significant morbidity, generating acute or chronic complications, severely affecting the quality of life in the best of cases, the vast majority occur during cholecystectomies andit is considered to be the result of an incorrect identification of the elements of Calot's triangle. Once presented, requires a comprehensive approach and a trained multidisciplinary team between surgeons, radiologists, and endoscopists(AU)