EM · Toxicology and environmental emergencies

Salicylate poisoning

Also known as Aspirin overdose · Salicylism · Chronic salicylate intoxication · Oil of wintergreen poisoning · Methyl salicylate toxicity

Salicylate (aspirin) poisoning — the uncoupling of oxidative phosphorylation (fever, hypermetabolism), the direct stimulation of the respiratory centre (respiratory alkalosis), and the Krebs-cycle interference (high anion gap metabolic acidosis), producing the classic mixed respiratory alkalosis and high anion gap metabolic acidosis on the blood gas. The clinical picture is tinnitus, hyperventilation, sweating, vomiting, agitation, dehydration and hyperthermia. Management is activated charcoal 50 g, sodium bicarbonate 1 to 2 mmol/kg IV for alkaline diuresis (urine pH above 7.5 enhances salicylate excretion), IV fluid, potassium replacement, and haemodialysis for the severe case (EXTRIP: concentration over 100 mg/dL, altered mental status, ARDS on oxygen, failing therapy, pH 7.20 or less, renal failema). Intubation is avoided where possible because loss of the respiratory compensation worsens the acidosis. ACEM-primary, globally tagged.