SALICYLATE POISONING

See Treatment of salicylate poisoning

Overview

  ACUTE TOXICITY CHRONIC TOXICITY
Epidemiology Accidental ingestion in children

Suicide attempts in adults

Accidental in the elderly with rheumatological conditions

(decreased renal function, large Vd, decreased protein, often dehydrated, poor nutrition)

Chronology may be preceded by relatively asymptomatic period often gradual and insidious
(ingestion over > 12 hrs)
Symptoms

Initial

  • Anorexia, nausea and vomiting

  • Tinnitus and decreased hearing (early)

  • Hyperpnea/respiratory alkalosis 

  • Hyperglycaemia

Later

  • Metabolic acidosis

  • Hyperthermia

  • Memory loss/mental status changes - lethargy, disorientation, and hallucinations

Differential Diagnosis
  • Theophylline/Caffeine toxicity

  • Acute iron poisoning

  • Reye’s syndrome

  • Diabetic ketoacidosis

  • Sepsis

  • Meningitis

  • Acute myocardial infarction

  • Encephalitis

  • Stroke

  • Ketoacidosis.

Salicylate levels >40 mg/dL or 2.3 mmol/L is toxic

Correlates poorly with clinical effects 

Treatment Treat if symptomatic or > 150mg/kg or > 40mg/dL Treat on symptoms

Mortality

1% 25%

COMPLICATIONS

HYPERSENSITIVITY

ASSESSMENT

Confirm ingestion

Estimate severity

Type, Amount, Time of ingestion, Chronicity

Serum levels/Ingested Dose

Dose (mg/kg)

Serum Level (mg/dL)

Estimated Severity

Clinical Features

<150

<40

Minimal GIT intolerance, bleeding
Hypersensitivity 
Acute gout

150-300

40-110

Mild-to-moderate  Tinnitus, deafness, vertigo
Nausea & vomiting, dehydration
Fever
Hyperventilation
Respiratory alkalosis/Metabolic acidosis

300-500

110-160

Serious  Circulatory collapse
Coma
Coagulopathy

>500

>160

Potentially lethal cerebral oedema

Complicating issues

See Treatment of salicylate poisoning

See Basic Pharmacology of Salicylates

See Toxicology of Salicylates