Salicylate Poisoning



  • 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


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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