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Salicylate Poisoning

Salicylates

Salicylate poisoning, especially in the form of aspirin, occurs frequently, in spite of some decline in its use in children because of Reye syndrome. The presentation depends on the age of the affected person, and on the acute or chronic nature of the poisoning. Treatment is with activated charcoal, alkaline diuresis, or in the most serious cases by hemodialysis.


Presentation

Salicylates remain one of the most widely used medications, and poisoning – both voluntary and accidental – is common. Aspirin is taken for its analgesic and antipyretic, or antiplatelet effects, but salicylates are also present in drugs in non-aspirin forms, such as methyl salicylate (oil of wintergreen) in liniments, and bismuth sub-salicylate in Pepto Bismol. Salicylates cause toxicity both through ingestion and dermal absorption. Aspirin poisoning is not easy to diagnose and is not always identified, especially in cases of chronic usage, when the symptoms may be atypical or misleading [1].

Salicylates impair the metabolism of all tissues through uncoupling oxidative phosphorylation and inhibiting the function of the Krebs cycle. In addition, drugs based on salicylate have organ-specific physiological responses like stimulation of the respiratory center.

In early stages, patients with acute poisoning most often present with nausea and vomiting because of gastrointestinal irritation and hyperventilation due to stimulation of respiration [3], and tinnitus [2], a characteristic although a non-specific sign of salicylate poisoning. Other signs are diaphoresis, hyperactivity, and tachycardia. Hyperventilation leads to respiratory alkalosis, but not typically in children. Once metabolic disturbances become prominent, the inhibition of aerobic respiration and activation of lipid breakdown lead to accumulation of lactic acid and ketone bodies, and consequently to aciduria and metabolic acidosis. Thus, a mixed acid-base disorder is generated. Late signs are fever, agitation, or conversely, lethargy, convulsions, and stupor. Patients in late stages may be mistakenly diagnosed as suffering from sepsis [4], having a heart attack [5], or being agitated.

Several organ systems are affected, and a variety of signs may be observed. Pulmonary edema is somewhat more frequent in chronic toxicity in the elderly population. Central nervous system (CNS) deterioration can also occur, especially in acidosis, which increases the proportion of uncharged salicylate molecules that are able to cross the blood-brain barrier. CNS toxicity can contribute to vomiting. In severe cases, the condition progresses to cerebral edema, seizures, coma, and death. The inhibition of prostaglandin and thromboxane synthesis is accompanied by increased bleeding times, gastrointestinal (GI) irritation, and, in chronic poisoning, GI bleeding.

Glucose metabolism is also disturbed, leading usually to hypoglycemia, and there is no correspondence between serum glucose levels and cerebrospinal fluid glucose content [6]. Thus, blood glucose levels may not adequately reflect mental responses of the patient. Other blood chemistry changes are dehydration, hypokalemia, and hypocalcemia.

Chronic toxicity may be difficult to recognize, especially in the elderly, because the symptoms are nonspecific (confusion, fever, dehydration and others), and because a confused patient may not remember having taken salicylates. Renal insufficiency exacerbates salicylate poisoning since most of the drug is eliminated by the kidneys [7].

Fever
  • OTC drugs were the first-line treatment in 188 (74 percent) of 254 fever episodes during the 2 weeks before the cross-sectional survey.[ncbi.nlm.nih.gov]
  • Salicylate poisoning also causes ketosis, fever, and, even when systemic hypoglycemia is absent, low brain glucose levels.[msdmanuals.com]
  • Fever can be treated with physical measures such as external cooling . Seizures are treated with benzodiazepines.[merckmanuals.com]
  • Late signs are fever, agitation, or conversely, lethargy, convulsions, and stupor. Patients in late stages may be mistakenly diagnosed as suffering from sepsis, having a heart attack, or being agitated.[symptoma.com]
  • Aspirin (acetylsalicylic acid) and other salicylates are present in many over-the-counter (OTC) drugs which are used as analgesics (pain relievers), antipyretics (for controlling fever), and anti-inflammatory medicines.[healthhype.com]
Gastric Lavage
  • Treatment options include induction of emesis or diuresis, gastric lavage, administration of activated charcoal, and surgery.[ncbi.nlm.nih.gov]
  • After examination, the patient was prescribed urine alkalinisation, gastric lavage and saline to correct hydroelectrolytic alterations, and admitted to the intensive care unit.[revistanefrologia.com]
  • This treatment method, which cleanses the digestive tract, has nearly completely replaced gastric lavage and is fully indicated for cases of salicylate poisoning. 5 We believe it necessary to stress that indications for renal and extrarenal clearance[revistanefrologia.com]
  • Another useful method for the treatment of salicylate poisoning is gastric lavage which involves insertion of a large tube for the suction of the stomach contents. Lavage needs to be accompanied by injections of saline.[ic.steadyhealth.com]
  • In children, gastric lavage may be done even if 24 hours have elapsed since ingestion of the drug. Metabolic acidosis should be treated with intravenous sodium bicarbonate. Urinary alkalization or forced alkaline diuresis. Peritoneal dialysis .[healthhype.com]
Tachypnea
  • GI: Nausea Vomiting Epigastric pain Hematemesis Pulmonary: Tachypnea Noncardiogenic pulmonary edema CNS: Tinnitus Deafness Delirium Seizures Coma In suspected overdose settings, medication bottles must be brought in for review Initial Stabilization/Therapy[5minuteconsult.com]
  • In general, this should occur regardless of the dose reported (Grade D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion[ncbi.nlm.nih.gov]
  • There are also certain respiratory manifestations which may also be induced by salicylate poisoning and those include adult respiratory distress syndrome, noncardiogenic pulmonary edema, apnea, hyperpnea and tachypnea.[ic.steadyhealth.com]
  • Patients with tachypnea are able to compensate for the profound metabolic acidosis that can develop from salicylate poisoning.[rebelem.com]
  • "Sudden-onset tachypnea and confusion in a previously healthy teenager". Ther Drug Monit. vol. 32. 2010. pp. 700-703. Glisson, JK, Vesa, TS, Bowling, MR. "Current management of salicylate-induced pulmonary edema".[clinicaladvisor.com]
Hyperpnea
  • In general, this should occur regardless of the dose reported (Grade D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion[ncbi.nlm.nih.gov]
  • […] decreased protein, often dehydrated, poor nutrition) Chronology may be preceded by relatively asymptomatic period often gradual and insidious (ingestion over 12 hrs) Symptoms Initial Anorexia, nausea and vomiting Tinnitus and decreased hearing (early) Hyperpnea[emedsa.org.au]
  • Hyperpnea is an early finding of toxicity, as salicylates can act directly on the medullary respiratory center leading to hyperventilation leading to a respiratory alkalosis.[ukidney.com]
  • There are also certain respiratory manifestations which may also be induced by salicylate poisoning and those include adult respiratory distress syndrome, noncardiogenic pulmonary edema, apnea, hyperpnea and tachypnea.[ic.steadyhealth.com]
  • N/V, tinnitus, vertigo, hyperpnea, diarrhea Describe the following for moderate ASA toxicity: 1. amount ingested 2. manifestations 1. 200-300mg/kg 2.[quizlet.com]
Vomiting
  • Ringing in the ears (tinnitus), nausea, vomiting, and diaphoresis are other common symptoms. Severe intoxications produce hyperthermia, mental status changes, and pulmonary edema.[medical-dictionary.thefreedictionary.com]
  • CNS toxicity can contribute to vomiting. In severe cases, the condition progresses to cerebral edema, seizures, coma, and death.[symptoma.com]
  • […] conditions (decreased renal function, large Vd, decreased protein, often dehydrated, poor nutrition) Chronology may be preceded by relatively asymptomatic period often gradual and insidious (ingestion over 12 hrs) Symptoms Initial Anorexia, nausea and vomiting[emedsa.org.au]
  • For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 Background Acute intoxication presents with classical symptoms of vomiting, tinnitus, hyperventilation, respiratory alkalosis and metabolic acidosis.[rch.org.au]
Nausea
  • […] rheumatological conditions (decreased renal function, large Vd, decreased protein, often dehydrated, poor nutrition) Chronology may be preceded by relatively asymptomatic period often gradual and insidious (ingestion over 12 hrs) Symptoms Initial Anorexia, nausea[emedsa.org.au]
  • Ringing in the ears (tinnitus), nausea, vomiting, and diaphoresis are other common symptoms. Severe intoxications produce hyperthermia, mental status changes, and pulmonary edema.[medical-dictionary.thefreedictionary.com]
  • Aspirin is also known to irritate the gastric mucosa by means of inhibiting cyclooxygenase, leading to nausea and vomiting, sometimes severe enough to cause hemorrhagic gastritis.[ukidney.com]
  • In overdose it causes a variety of symptoms – nausea,vomiting, sweating and tinnitus. Dizziness tachycardia and hyperventilation also occur. More severe poisoning can lead to delirium, agitation and convulsions.[gcs3.co.uk]
  • Home CCC Salicylate Poisoning by, last update April 2, 2019 OVERVIEW mechanisms of toxicity: acid-base disturbance, uncoupling of oxidative phosphorylation, disordered glucose metabolism aspirin CLINICAL FEATURES nausea, vomiting, abdominal pain, tinnitus[lifeinthefastlane.com]
Hematemesis
  • GI: Nausea Vomiting Epigastric pain Hematemesis Pulmonary: Tachypnea Noncardiogenic pulmonary edema CNS: Tinnitus Deafness Delirium Seizures Coma In suspected overdose settings, medication bottles must be brought in for review Initial Stabilization/Therapy[5minuteconsult.com]
  • Possible gastrointestinal manifestations induced by salicylate poisoning include oropharyngeal burns, peptic ulcers accompanied by perforation or bleeding, hematemesis, vomiting and abdominal pain.[ic.steadyhealth.com]
  • In general, this should occur regardless of the dose reported (Grade D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion[ncbi.nlm.nih.gov]
  • Five minute evaluation 1) abnormal VS - increased RR,increased Vt, Temp 2) mental status - tinnitus, lethargy, AMS, confusion 3) noncardiogenic pulmonary edema 4) abdominal Sx - n,v, pain, blood-tinged vomitus, gross hematemesis 5) urine - FeCl3, ketones[mcgill.ca]
Tachycardia
  • Dizziness tachycardia and hyperventilation also occur. More severe poisoning can lead to delirium, agitation and convulsions.[gcs3.co.uk]
  • Other signs are diaphoresis, hyperactivity, and tachycardia. Hyperventilation leads to respiratory alkalosis, but not typically in children.[symptoma.com]
  • Earliest Sign of Salicylate Toxicity Nausea and vomiting Tinnitus Diaphoresis or sweating Other Early Sypmtoms Tachycardia Vertigo Hyperventilation Hyperactivity Symptoms occurring as the toxicity or poisoning progresses: Agitation Delirium Disorientation[nursingcrib.com]
  • Other early symptoms and signs are vertigo, hyperventilation, tachycardia, and hyperactivity. As toxicity progresses, agitation, delirium, hallucinations, convulsions, lethargy, and stupor may occur.[emedicine.medscape.com]
Hypotension
  • After 5 hours, despite receiving treatment, the patient experienced decreased cognitive state, hypotension and oliguric renal failure, and we then decided to start haemodialysis treatment.[revistanefrologia.com]
  • They include subtle confusion, changes in mental status, fever, hypoxia, noncardiogenic pulmonary edema, dehydration, lactic acidosis, and hypotension.[merckmanuals.com]
  • Coma, and Death Coagulopathy Pylorospasm, decreased gastro intestinal motility (acute) Gastric erosions, Iron deficiency anaemia (in chronic) ARDS (chronic severe toxicity) Renal tubular damage (rare) Haemolysis (rare) HYPERSENSITIVITY Bronchospasm, hypotension[emedsa.org.au]
  • Hypotension or low blood pressure. Heart block. Pulmonary edema. Cerebral edema . Hyperthermia or elevated body temperature (read more on drug fever ). Hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). Renal failure.[healthhype.com]
Tinnitus
  • (decreased renal function, large Vd, decreased protein, often dehydrated, poor nutrition) Chronology may be preceded by relatively asymptomatic period often gradual and insidious (ingestion over 12 hrs) Symptoms Initial Anorexia, nausea and vomiting Tinnitus[emedsa.org.au]
  • Ringing in the ears (tinnitus), nausea, vomiting, and diaphoresis are other common symptoms. Severe intoxications produce hyperthermia, mental status changes, and pulmonary edema.[medical-dictionary.thefreedictionary.com]
  • For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 Background Acute intoxication presents with classical symptoms of vomiting, tinnitus, hyperventilation, respiratory alkalosis and metabolic acidosis.[rch.org.au]
  • In overdose it causes a variety of symptoms – nausea,vomiting, sweating and tinnitus. Dizziness tachycardia and hyperventilation also occur. More severe poisoning can lead to delirium, agitation and convulsions.[gcs3.co.uk]
Seizure
  • Tetany Seizures, Cerebral oedema, Coma, and Death Coagulopathy Pylorospasm, decreased gastro intestinal motility (acute) Gastric erosions, Iron deficiency anaemia (in chronic) ARDS (chronic severe toxicity) Renal tubular damage (rare) Haemolysis (rare[emedsa.org.au]
  • Intoxication is characterized by rapid breathing, vomiting, headache, irritability, ketosis, hypoglycemia, and, in severe cases, seizures and respiratory failure. salicylate poisoning Poisoning caused by aspirin or one of its derivatives.[medical-dictionary.thefreedictionary.com]
  • […] hyperventilation & respiratory alkalosis Nausea and Vomiting Tinnitus Renal potassium loss with hypokalaemia Dehydration High AG metabolic acidosis Hypoglycaemia (can be hyperglycaemia) Hypocalcaemia Pyrexia CNS toxicity: confusion, hallucinations, seizures[emergpa.net]
  • Life-threatening consequences of salicylate overdose include: Seizures Cerebral and pulmonary oedema.[kidshealthwa.com]
  • GI: Nausea Vomiting Epigastric pain Hematemesis Pulmonary: Tachypnea Noncardiogenic pulmonary edema CNS: Tinnitus Deafness Delirium Seizures Coma In suspected overdose settings, medication bottles must be brought in for review Initial Stabilization/Therapy[5minuteconsult.com]
Agitation
  • Late signs are fever, agitation, or conversely, lethargy, convulsions, and stupor. Patients in late stages may be mistakenly diagnosed as suffering from sepsis, having a heart attack, or being agitated.[symptoma.com]
  • More severe poisoning can lead to delirium, agitation and convulsions. Salicylates stimulate the respiratory centre of the brain and uncouple oxidative phosphorylation Aspirin is rapidly hydrolysed to salicylate in the GI tract and blood.[gcs3.co.uk]
  • Earliest Sign of Salicylate Toxicity Nausea and vomiting Tinnitus Diaphoresis or sweating Other Early Sypmtoms Tachycardia Vertigo Hyperventilation Hyperactivity Symptoms occurring as the toxicity or poisoning progresses: Agitation Delirium Disorientation[nursingcrib.com]
  • This progressive acidosis can promote the influx of salicylic acid into the central nervous system leading to altered mental status, confusion and agitation.[ukidney.com]
Confusion
  • Chronic toxicity may be difficult to recognize, especially in the elderly, because the symptoms are nonspecific (confusion, fever, dehydration and others), and because a confused patient may not remember having taken salicylates.[symptoma.com]
  • […] warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of[ncbi.nlm.nih.gov]
  • They include subtle confusion, changes in mental status, fever, hypoxia, noncardiogenic pulmonary edema, dehydration, lactic acidosis, and hypotension.[merckmanuals.com]
  • Salicylate poisoning can cause vomiting, tinnitus, confusion, hyperthermia, respiratory alkalosis, metabolic acidosis, and multiple organ failure.[msdmanuals.com]
  • Chronic salicylate poisoning may cause anxiety, tachypnoea, diffuse sweating, difficulty concentrating, confusion, hallucinations and even agitated delirium. Elderly individuals may present with a deterioration in functional status.[patient.info]
Altered Mental Status
  • This progressive acidosis can promote the influx of salicylic acid into the central nervous system leading to altered mental status, confusion and agitation.[ukidney.com]
  • mental status (1D), with acute respiratory distress syndrome requiring supplemental oxygen (1D), and for those in whom standard therapy is deemed to be failing (1D) regardless of the salicylate concentration.[ncbi.nlm.nih.gov]
  • Activated charcoal Alkaline diuresis with extra KCl Unless contraindicated (eg, by altered mental status), activated charcoal is given as soon as possible and, if bowel sounds are present, may be repeated every 4 h until charcoal appears in the stool.[msdmanuals.com]
  • Treatment Activated charcoal Alkaline diuresis with extra KCl Unless contraindicated (eg, by altered mental status), activated charcoal is given as soon as possible and, if bowel sounds are present, may be repeated every 4 h until charcoal appears in[merckmanuals.com]
Vertigo
  • Large overdose has prolonged peak effect Serum levels/Ingested Dose Dose (mg/kg) Serum Level (mg/dL) Estimated Severity Clinical Features Minimal GIT intolerance, bleeding Hypersensitivity Acute gout 150-300 40-110 Mild-to-moderate Tinnitus, deafness, vertigo[emedsa.org.au]
  • Earliest Sign of Salicylate Toxicity Nausea and vomiting Tinnitus Diaphoresis or sweating Other Early Sypmtoms Tachycardia Vertigo Hyperventilation Hyperactivity Symptoms occurring as the toxicity or poisoning progresses: Agitation Delirium Disorientation[nursingcrib.com]
  • Willow bark Assessment Features on history Ingestion Formulation -immediate release or sustained release Dose Time Co-ingestants Accidental or intentional Symptoms may be minimal initially with severe toxicity not evident until 6-12 hours CNS : Tinnitus, vertigo[rch.org.au]

Workup

The “Done nomogram” [8] was developed in 1960 for predicting salicylate toxicity after a single dose of ingestion [1]. Although successful in many cases, the premises used in its formulation restrict its general applicability [9], and it is not recommended for general use.

Serum salicylate levels do not always reflect the severity of poisoning. A general guide specifies 30 mg/dL above which symptoms usually appear, and 100 mg/dL above which the effects of poisoning may be fatal. Serial salicylate and arterial blood gas levels are more important for the better evaluation of the situation and for following acid-base alterations. A peak value may not be reached up to 4-6 hours after ingestion. Some salicylate tablets have a tendency to form a concretion in the stomach [10], in which case the serum concentrations will keep increasing for a longer time.

Levels of serum electrolytes, creatinine, blood urea nitrogen, and potassium (which may become very low if the patient is alkalinized), should be followed until salicylate concentrations start declining and anomalies are resolved. Urine pH should also be monitored. An abdominal radiograph or other imaging may be necessary if the formation of a concretion is suspected.

Hypocapnia
  • No significant difference of Pco(2) between the two groups was found, and hence no simple relationship exists between hypocapnia and the development of acidaemia in salicylate poisoning.[ncbi.nlm.nih.gov]
  • In experimental animals, lactate accumulation is minimal if the initial fall in PCO2 is prevented, but it gradually becomes more prominent as hypocapnia is allowed to occur [12].[prep4usmle.com]
Hypercapnia
  • The issue with intubation is the inability to keep up with the hyperventilation necessary to avoid hypercapnia and worsening acidosis, both of which can lead to cardiac arrest.[rebelem.com]
Plasmodium Falciparum
  • METHODS All children admitted to Kilifi District Hospital between July and September, 1994, who had a positive blood film for Plasmodium falciparum, and one or more of coma, prostration, or respiratory distress were eligible.[ncbi.nlm.nih.gov]

Treatment

  • treatments), fair (did not advocate any contraindicated treatments but did list some simple futile treatments) or poor (advocated contraindicated or complicated futile treatments, such as unnecessary hemodialysis).[ncbi.nlm.nih.gov]
  • The indications for extracorporeal treatments such as hemodialysis are poorly defined.[ncbi.nlm.nih.gov]
  • One of the more popular and successful treatments has been forced alkaline diuresis to encourage excretion.[ncbi.nlm.nih.gov]
  • Treatment options include induction of emesis or diuresis, gastric lavage, administration of activated charcoal, and surgery.[ncbi.nlm.nih.gov]
  • They are correct in doubting that we started urine acidification treatment because the text later goes on to state that urine alkalinisation treatment was required.[revistanefrologia.com]

Prognosis

  • Acidaemia is shown to be associated with impaired consciousness and to carry a grave prognosis.[ncbi.nlm.nih.gov]
  • The prognosis of acute salicylate poisoning cannot be determined from the plasma concentration of the drug alone. Clinical features, particularly impaired consciousness, and the arterial hydrogen ion concentration must be taken into consideration.[ncbi.nlm.nih.gov]
  • Prognosis  The prognosis in patients with acute salicylate poisoning is very good: the mortality rate is 1%, and the morbidity rate is 16%  The prognosis is worse in patients with chronic salicylate poisoning: the mortality rate is 25%, and the morbidity[slideshare.net]
  • More severe symptoms (with a poorer prognosis) include hyperthermia, hypovolemia, altered mental status, acute pulmonary edema, ventricular arrhythmias, hepatic insufficiency, acute renal failure.[sjrhem.ca]

Etiology

  • Incidence/prevalence in the United States 11,100 single-substance ingestions of acetylsalicylic acid or ASA-combination products reported by poison control centers in 2011 22 deaths in 2011, none in children Occurs in children and adults at any age Etiology[unboundmedicine.com]
  • If difficulty in achieving urinary alkalinization occurs, hypokalemia, volume depletion, or excretion of organic acids are possible etiologies.[mcgill.ca]
  • Clinical Manifestations Salicylate toxicity should be suspected in any patient with fever, hyperventilation, seizures or coma of uncertain etiology.(5) It is not uncommon for salicylate poisoning to be misdiagnosed initially as diabetic ketoacidosis.([drplace.com]

Epidemiology

  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • […] frequently missed diagnosis (up to 50%) Mortality/Morbidity - particularly high if untreated Appropriate treatment involves good supportive care, adequate re-hydration with urinary alkalisation and potassium replacement ACUTE TOXICITY CHRONIC TOXICITY Epidemiology[emedsa.org.au]
  • PubMed CrossRef Google Scholar Epidemiology Sibert JR, Craft AW, Jackson RH. Child-resistant packaging and accidental child poisoning. Lancet 1977; ii: 289–90. CrossRef Google Scholar Pharmacokinetics Levy G. Clinical pharmacokinetics of aspirin.[link.springer.com]
  • Increased risk of ante- and intrapartum hemorrhage Epidemiology Incidence/prevalence in the United States 11,100 single-substance ingestions of acetylsalicylic acid or ASA-combination products reported by poison control centers in 2011 22 deaths in 2011[unboundmedicine.com]
  • […] odsalicylates epidemiology salicylate (eg. aspirin (acetylsalicylic acid) , teething gels) poisoning has steadily declined over the past 10-15 yrs in parallel with the declining use of aspirin particularly in children, and the use of child resistant packaging[ozemedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of aspirin overdosage toxicity, with implications for management. Pediatrics 1978; 69: Suppl. 873–6. Google Scholar Pulmonary Oedema Bowers RE, Brigham KL, Owen PJ.[link.springer.com]
  • […] prevalence in the United States 11,100 single-substance ingestions of acetylsalicylic acid or ASA-combination products reported by poison control centers in 2011 22 deaths in 2011, none in children Occurs in children and adults at any age Etiology and Pathophysiology[unboundmedicine.com]
  • […] ph stomach contents concurrent ingestions Aspirin (acetylsalicylate, pka 3.5) is quickly hydrolysed to salicylic acid (pka 3.0) which is further metabolised by enzymes that are readily saturable and thus in OD the metabolites are eliminated slowly; pathophysiology[ozemedicine.com]
  • Pathophysiology Salicylates impair cellular respiration by uncoupling oxidative phosphorylation. They stimulate respiratory centers in the medulla, causing primary respiratory alkalosis , which is often unrecognized in young children.[merckmanuals.com]
  • […] so testy in here... off of merck's own website: " Pathophysiology Salicylates impair cellular respiration by uncoupling oxidative phosphorylation.[forums.studentdoctor.net]

Prevention

  • Due to the limited options available in managing such patients in many developing countries, emphasis should be placed on prevention of poisoning by educating the community and health care providers.[ncbi.nlm.nih.gov]
  • If a case of salicylate poisoning is to be treated with hemodialysis, treatment with alkalinization should still be given without delay, in order to prevent acidemia and to promote elimination of as much salicylate as possible via the kidneys.[ncbi.nlm.nih.gov]
  • Abstract The treatment of salicylate poisoning is based on the prevention of further absorption, and enhancement of excretion of already absorbed drug. A variety of methods based on this rationale have been used over the years.[ncbi.nlm.nih.gov]
  • This can counter the salicylate anions within the tubules of the kidney and prevent spread into systemic circulation and ultimately prevent further crossing into the blood brain barrier. Salicylates can be removed via ECTR.[ukidney.com]
  • Due to its antiplatelet effect, aspirin is prescribed in low doses for prevention of heart attack, stroke, and blood clot formation, and also after a heart attack to prevent future episodes of myocardial infarction.[healthhype.com]

References

Article

  1. O'Malley GF. Emergency department management of the salicylate-poisoned patient. Emerg Med Clin North Am. 2007 May;25(2):333-346.
  2. Stolzberg D, Salvi RJ, Allman BL. Salicylate toxicity model of tinnitus. Front Syst Neurosci. 2012 Apr 20;6:28.
  3. Proudfoot AT. Toxicity of salicylates. Am J Med. 1983 Nov 14;75(5A):99-103.
  4. Chalasani N, Roman J, Jurado RL. Systemic inflammatory response syndrome caused by chronic salicylate intoxication. South Med J. 1996 May;89(5):479-482.
  5. Paul BN. Salicylate poisoning in the elderly: diagnostic pitfalls. J Am Geriatr Soc. 1972 Aug;20(8):387-390.
  6. Yip L, Dart RC, Gabow PA. Concepts and controversies in salicylate toxicity. Emerg Med Clin North Am. 1994 May;12(2):351-364.
  7. Chin RL, Olson KR, Dempsey D. Salicylate toxicity from ingestion and continued dermal absorption. Cal J Emerg Med. 2007 Feb;8(1):23-25.
  8. Done AK. Salicylate intoxication. Significance of measurements of salicylate in blood in cases of acute ingestion. Pediatrics. 1960 Nov;26:800-807.
  9. Dugandzic RM, Tierney MG, Dickinson GE, et al. Evaluation of the validity of the Done nomogram in the management of acute salicylate intoxication. Ann Emerg Med. 1989 Nov;18(11):1186-1190.
  10. Taylor JR, Streetman DS, Castle SS. Medication bezoars: a literature review and report of a case. Ann Pharmacother. 1998 Sep;32(9):940-946.

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Last updated: 2018-06-22 03:13