Salicylate Poisoning

OVERVIEW

• aspirin
  mechanisms of toxicity: acid-base disturbance, uncoupling of oxidative phosphorylation, disordered glucose metabolism

CLINICAL FEATURES

• nausea, vomiting, abdominal pain, tinnitus
• deafness, hyperventilation, flushed skin, sweating, hyperthermia
• may aspirate, pulmonary oedema and ARDS
• cardiovascular instability

INVESTIGATIONS

• high salicylate level (mild – < 500mg/L, moderate 500-750mg/L, severe > 750mg/L)
• metabolic acidosis – lactate
• respiratory alkalosis – hyperventilation
• ECG: widened QRS, AV block, ventricular arrhythmias
• hypoglycaemia or hyperglycaemia
• hypokalaemia
• hypoprothrombinaemia
• thrombocytopaenia
• DIC
• renal failure

MANAGEMENT

Resuscitation

• maintain intravascular volume
• intubate if unrousable

Acid-base and Electrolyte Abnormalities

• glucose infusion if hypoglycaemic
• correct electrolytes
• vitamin K if hypoprothrombinaemia
• sodium bicarbonate for severe acidosis
• no role for forced alkaline diuresis any more
• dialysis in moderate to severe cases

Specific Treatment

• supportive care

Underlying Cause