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Salicylate Poisoning

Salicylate Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • 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 dosageincrement 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.


Sources of salicylate:
  • 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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Rosen, Peter, et al., editors. "Salicylate Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/1.3/Salicylate_Poisoning.
Salicylate Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/1.3/Salicylate_Poisoning. Accessed August 20, 2019.
Salicylate Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/1.3/Salicylate_Poisoning
Salicylate Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 August 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/1.3/Salicylate_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Salicylate Poisoning ID - 307527 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307527/1.3/Salicylate_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -