Salicylate Toxicity

Question 1

How does salicylate toxicity occur?

Answer 1

May occur from acute or chronic use of acetylsalicylic acid. Toxicity of chronic use is usually seen in the elderly patients with chronic underlying disease. They may present with symptoms that mimic sepsis.

Question 2

What are the subjective/physical exam findings associated with salicylate toxicity?

Answer 2

• Subjective: N/V, fever, tinnitus, headache, dizziness
• Physical findings: Tachypnea, cyanosis, metabolic acidosis, respiratory alkalosis, dehydration, hyperthermia

Question 3

How do you manage a patient with salicylate toxicity?

Answer 3

1. Monitor serum salicylate concentrations well as electrolytes
2. Volume replacement with Normal Saline at 100 cc/hr. Be careful in fluid administration in the elderly.
3. Activated charcoal 1 gram/kg PO after checking a serum salicylate concentration. Patients generally require treatment for concentrations > 30 mg/dl. Levels 10 mg/dl -30 mg/dl generally do not require treatment. Levels > 100 mg/dl are very serious and often fatal.
4. Severe acidosis (pH < 7.2) give sodium bicarb 1-1.5 mEq/kg/ IV over 10 minutes
5. Consider hemodialysis if patient’s acid-base and/or electrolyte abnormalities are not responding