Salicylate Poisoning

by Chris Nickson, Last updated January 4, 2013

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

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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