Salicylate poisoning continues to be an important cause of drug related mortality. The zero order kinetics of salicylates at high doses is responsible in part for cases of iatrogenic poisoning. Serum levels tend to correlate with severity of poisoning in acute overdose cases only. Clinical manifestations include involvement of nervous system, hepatic and pulmonary systems along with metabolic disturbances. Measures at enhancing elimination and reducing absorption, while providing supportive care form the basis of management.
Twelve cases of post-anaesthetic pulmonary oedema (PO) secondary to upper airway obstruction (UAO) are reported. All were adult male patients undergoing uneventful elective surgical procedure under general anaesthesia. Post-anaesthetic laryngospasm was the single most important factor for the upper airway obstruction (UAO) in 5 (41.6%) patients. PO secondary to partial UAO in drowsy patients was observed in 4 (33.3%) patients. UAO due to foreign body was responsible for PO in two patients. A combination of negative intrathoracic pressure, hypoxia and associated hyperadrenergic state were the most likely causes of PO in these patients with UAO. Early recognition, maintenance of patent airway and adequate oxygenation via face mask or endotracheal tube with mechanical ventilation resolved the syndrome within 6-36 hours in all of these patients. Invasive haemodynamic monitoring or aggressive drug therapy were not applied in any of the patients. A heightened awareness among anaesthesiologists of the varied causes of post-anaesthetic UAO leading to PO may help reduce the occurrence and facilitate early management of the potential complications.
A drug addict suffering from tetanus is described in order to alert physicians into recognizing this life-threatening complication of parenteral drug abuse. This young man had used all accessible veins and started injecting heroin subcutaneously. This resulted in numerous cutaneous ulcers and abscesses-the probable site of Clostridium tetani infection. Prompt recognition and appropriate management resulted in complete recovery after a prolonged stay in the intensive care unit.
