Anesthesia in a patient with undiagnosed salicylate poisoning presenting as intraabdominal sepsis

An 81-year-old woman with unintentional salicylate intoxication presented w ith features of sepsis, abdominal pain, and tenderness. Laparotomy was perf ormed to rule out acute cholecystitis. Anesthesia was complicated by severe hypercarbia despite hyperventilation, and progressive cardiovascular and n eurologic deterioration postoperatively. The adverse neurologic, respirator y, and hepatic effects of abdominal surgery and general anesthesia probably potentiated salicylate toxicity and increased patient morbidity. Anesthesi ologists should be aware of the protean manifestations of salicylate poison ing and consider it as a cause of "medical abdomen. " (C) 1999 by Elsevier Science Inc.