Salicylate Overdose

Toxicology

See treatment and investigations.

Clinical features

  • Tinnitus, hyperventilation, GI upset
  • Mixed respiratory alkalosis + metabolic acidosis
  • Fever, hypoglycaemia, cerebral oedema (severe)

Investigations

  • Serial salicylate levels
  • ABG, glucose, U&E, coag

Management

  • Activated charcoal if <1 h and awake
  • Urinary alkalinisation: NaHCO3 1.5% infusion, target urine pH 7.5-8
  • Haemodialysis if level >100 mg/dL (>50 chronic), refractory acidosis, renal failure, altered mental state, cerebral/pulmonary oedema
  • Correct K+ (need K+ >4 for alkalinisation)

Educational — verify locally.

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