Salicylate Poisoning
Basics
Description
Description
- Respiratory alkalosis and metabolic acidosis:
- Secondary to inhibition of Krebs cycle and uncoupling of oxidative phosphorylation
- Dehydration, hyponatremia or hypernatremia, hypokalemia, hypocalcemia:
- Owing to increased sweating, vomiting, tachypnea
- Noncardiogenic pulmonary edema:
- Because of toxic effect of salicylate on pulmonary endothelium resulting in extravasation of fluids
- Salicylate pharmacokinetics change from first order to zero order in overdose setting; i.e., a small dosage increment results in a large increase in salicylate concentration
Geriatric Considerations
- Greater morbidity
- Respiratory distress/altered mental status indicative of severe toxicity
- Diagnosis of salicylate intoxication delayed because underlying disease states mask signs and symptoms; e.g., CHF
Pediatric Considerations
- Children exhibit faster onset and more severe signs and symptoms than adults:
- Results from salicylate being distributed more quickly into target organs such as brain, kidney, and liver
- Respiratory alkalosis (hallmark of salicylate poisoning in adults) may not occur in children
- Metabolic acidosis occurs more quickly in children than in adults
- Hypoglycemia more common than hyperglycemia
- Ingestion of more than “a taste” of oil of wintergreen (98% methyl salicylate) by children <6 yr or >4 mL of oil of wintergreen by patients >6 yr warrants ED assessment
Etiology
Sources of salicylate:Etiology
- Aspirin:
- Ingestion of >150 mg/kg can cause serious toxicity
- Oil of wintergreen:
- Any exposure should be considered dangerous
- Bismuth subsalicylate
- Salicylsalicylic acid (salsalate)
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Citation
Schaider, Jeffrey J., et al., editors. "Salicylate Poisoning." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/0.0/Salicylate_Poisoning.
Salicylate Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/0.0/Salicylate_Poisoning. Accessed October 15, 2024.
Salicylate Poisoning. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/0.0/Salicylate_Poisoning
Salicylate Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 15]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/0.0/Salicylate_Poisoning.
* Article titles in AMA citation format should be in sentence-case
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T1 - Salicylate Poisoning
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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