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)