Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
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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.
- 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
- 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.
EtiologySources of salicylate:
- Ingestion of >150 mg/kg can cause serious toxicity
- Oil of wintergreen:
- Any exposure should be considered dangerous.
- Bismuth subsalicylate
- Salicylsalicylic acid (salsalate)