Erschienen in:
01.09.2003 | Case Report
Aspirin Intoxication in a Child Associated with Myocardial
Necrosis: Is This a Drug-related Lesion?
verfasst von:
Y. Rocío Peña-Alonso, Miguel A. Montoya-Cabrera, Edgar Bustos-Córdoba, Lourdes Marroquín-Yáñez, Víctor Olivar-López
Erschienen in:
Pediatric and Developmental Pathology
|
Ausgabe 4/2003
Einloggen, um Zugang zu erhalten
Abstract
A 5-year-old girl with a mild upper airways
infection was admitted to the hospital because of sudden vomiting and
drowsiness that evolved to stupor; she was dehydrated, hypotensive, and
tachypneic; laboratory tests revealed noncompensated lactic acidosis. She also
had hypoglycemia followed by hyperglycemia, and progressive bradycardia leading
to reversible cardiac arrest. Her clinical condition complicated by sinus
bradycardia, ventricular tachycardia, third-degree atrioventricular blockage
and lethal asystole. At the final stage of her illness, the serum salicylate
concentration was 383.8 mcg/mL. Based on this single data, a retrospective
toxicological analysis estimated a theoretical peak level of serum salicylate
of approximately 1570 mcg/mL (therapeutic range, 20–250 mcg/mL) although
the real amount of aspirin that this child ingested is difficult to calculate
because aspirin is a drug that shows a so-called zero order kinetics. At
autopsy, the most striking finding was multiple foci of coagulative necrosis
involving the entire thickness of the myocardium with scant inflammatory
infiltrate composed mainly of macrophages and polymorphonuclear leukocytes. The
morphologic characteristics of the myocardial lesion in addition to salicylate
blood levels suggests the possibility of an adverse drug reaction of the type acute
toxic myocarditis.