Aspirin have analgesic, antipyretic and anti-inflammatory properties. Intoxication by this drug remains a significant clinical problem. She was discharged after completion of antibiotic treatment for endocarditis in good clinical condition. The patient presented elevated liver transaminases and prolonged prothrombin time (PT), with gradual improvement in subsequent days after supportive measures and use of sodium bicarbonate to alkalization of blood and urine. It was then suspected the diagnosis of salicylate intoxication or Reye's syndrome. Neurological examination revealed conjugate gaze deviation to the left, positive Babinski sign, mydriatic pupils and involuntary movements in upper and lower limbs (with normal head scan). Arterial blood gas analysis showed metabolic acidosis with an increased anion gap. After five days, despite the improvement of arthritis, she developed tinnitus, vomiting, decreased level of consciousness and convulsive seizure requiring orotracheal intubation and mechanical ventilation. Infective endocarditis and rheumatic fever were considered as likely diagnoses, and urgent mitral valve replacement with a bioprosthesis was performed with concomitant use of ceftriaxone, gentamicin, oxacillin and rifampicin for the first, and aspirin (total dose of 4 g/day) for the second raised diagnostic suspicion. Bedside transthoracic echocardiogram showed rupture of the chordae tendineae of the anterior leaflet of the mitral valve with severe mitral regurgitation and moderate tricuspid regurgitation. Results of laboratorial tests on admissionДЄfter 48 hours, the patient developed pulmonary congestion and tachycardia at rest being transferred to the intensive care unit.

Admission tests showed normocytic anemia, neutrophil leukocytosis, and also an increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels (Table 1). A previously healthy 15-year-old girl presented with intermittent fever (up to 39вЊ), migratory polyarthritis, arthralgia, orthopnea and progressive dyspnea in the last 30 days that led to dyspnea at rest and a new heart murmur requiring hospitalization.

Antidote for aspirin