Question

A client presents to the emergency department, dehydrated and with metabolic acidosis. An overdose of which drug can result in these problems? A. Digitalis B. Aspirin C. Insulin D. Acetaminophen

Short answer

B. Aspirin

Step-by-step solution

Understand the Symptoms

First, recognize the symptoms: dehydration and metabolic acidosis.

Identify Common Causes of Metabolic Acidosis

Metabolic acidosis can be caused by increased acid production, loss of bicarbonate, or reduced acid excretion.

Evaluate Drug Overdoses

Consider the drugs listed: Digitalis, Aspirin, Insulin, and Acetaminophen, and think about their effects on the body.

Analyze Aspirin Overdose

Aspirin (Salicylate) overdose can lead to respiratory alkalosis initially, followed by metabolic acidosis, and dehydration due to its toxic effects on metabolism.

Compare Other Drugs

Note that Digitalis affects the cardiovascular system, Insulin influences blood glucose, and Acetaminophen primarily causes liver damage, none are directly linked to metabolic acidosis and dehydration in the same way as Aspirin.

Conclude the Answer

Based on the symptoms and effects of the drugs, Aspirin overdose is most likely to cause dehydration and metabolic acidosis.

Key concepts

Metabolic Acidosis

Metabolic acidosis occurs when there's an excess of acid in the body or when the kidneys are not removing enough acid. It is a serious condition that affects the body's pH balance.
Common causes include:

• Increased acid production (e.g., lactic acidosis, diabetic ketoacidosis)
• Loss of bicarbonate (e.g., through diarrhea)
• Reduced ability of the kidneys to remove acid (e.g., kidney failure)

For example, in an aspirin overdose, the metabolism of salicylates produces excess acid, leading to metabolic acidosis. This condition requires urgent medical intervention to restore normal acid-base balance in the body.

Dehydration

Dehydration happens when the body loses more fluids than it takes in. It can be caused by several factors such as vomiting, diarrhea, severe burns, or excessive sweating.
In the case of an aspirin overdose, dehydration can occur due to multiple mechanisms. Aspirin can cause increased respiratory rate (leading to fluid loss through rapid breathing), vomiting, and reduced intake of fluids.
Signs of dehydration include:

• Dry mouth and skin
• Increased thirst
• Decreased urine output
• Dizziness or light-headedness

Severe dehydration can lead to complications like kidney failure, shock, or even death if not treated promptly.

Drug Overdose Effects

Drug overdoses can have varying effects on the body, depending on the substance involved.
An overdose of aspirin, for example, can cause initial respiratory alkalosis followed by metabolic acidosis as the body's compensatory mechanisms are overwhelmed. Other effects include dehydration, tinnitus (ringing in the ears), and gastrointestinal distress.
Here’s a quick overview of how the drugs mentioned in the exercise affect the body when overdosed:

• Digitalis: Primarily affects the heart, leading to arrhythmias.
• Insulin: Causes hypoglycemia, which can be life-threatening if not addressed.
• Acetaminophen: Overuse leads to liver damage and failure.

Since aspirin directly results in both dehydration and metabolic acidosis, it stands out among the options provided.

NCLEX-RN Examination

The NCLEX-RN is a licensing exam for registered nurses. It assesses the knowledge, skills, and abilities essential for safe and effective practice.
On the exam, candidates may encounter questions related to drug overdoses and their management. For instance, understanding the signs and symptoms of an aspirin overdose and the resulting conditions like metabolic acidosis and dehydration is crucial.
Here are some tips for the NCLEX-RN:

• Understand key symptoms and their causes
• Know the pharmacology of common drugs
• Be prepared to apply knowledge to clinical scenarios
• Practice with mock exams and scenarios

Mastering these areas can help ensure success on the NCLEX-RN and in a nursing career.