Salicylate Overdose

Salicylate toxicity is the great toxicologic mimicker!!!











Step 1: When to Suspect Salicylate Overdose











* Signs of CNS stimulation* Tachypnea* Hyperthermia* Altered mental status* Signs of GI irritation* Nausea/Vomiting* Abdominal pain* Common “mimicker”* Sepsis* Acute abdomen











Step 2: Testing Plan











* Electrolyte panel* Anion gap metabolic acidosis* Sodium – Chloride – Bicarb* Normal anion gap (AG) is <10* Caused by salicylic acid and lactic acid* Blood gas* Mixed respiratory ALKALOSIS and metabolic ACIDOSIS











Step 3: Obtain Serum Salicylate Level











Step 4: Treatment Plan











* Mild salicylate toxicity* Alkalinize urine with sodium bicarbonate (NaHCO3) drip* Severe salicylate toxicity* Dialysis











Additional Reading











* Salicylate Poisoning (LITFL)