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A. Symptoms / Laboratory Anomaliesnavigator

  1. Hyperpyrexia
  2. Gastrointestinal Bleeding
    1. Platelet Dysfunction
    2. Hypoprothrombinemia
  3. Hyperventilation
    1. Salicylates stimulate respiratory center
    2. Respiratory Alkylosis
  4. Metabolic Acidosis
  5. Tinnitus and Deafness
  6. Hypokalemia, interferance with glucose metabolism
  7. Renal Failure
  8. Hepatotoxicity (hepatitis, synthetic dysfunction)
  9. Respiratory Distress

B. Level of Intoxication and Featuresnavigator

  1. Mild (<30mg/dL)
    1. Tinnitis
    2. Deafness
  2. Moderate (30-70mg/dL)
    1. Vomiting
    2. Fever and Confusion
    3. Acidosis, Hypokalemia
  3. Severe (>70mg/dL)
    1. Pulmonary edema
    2. Cardiorespiratory Failure
    3. Coma

C. Diagnosis navigator

  1. Laboratory evaluation consistent with diagnosis diagnosis
    1. Metabolic acidosis
    2. Respiratory alkalosis
    3. Change in Anion Gap divided by change in bicarbonate < 1 indicates mixed disorder
  2. Salicylate Level
    1. Serum level determination is critical
    2. Dialysis required if level >90-100mg/dl or if patient is unstable
    3. Otherwise, supportive therapy usually sufficient (see below)
    4. Note: salicylate level may be estimated by following the anion gap
  3. Underlying disease - may reduce threshhold for dialysis, intubation, etc.

D. Treatment [1]navigator

  1. Nothing by mouth
  2. Intravenous fluids with electrolyte replacements and glucose infusion
  3. Bicarbonate in intravenous fluid
    1. Maintain serum pH 7.45-7.50 range (50-100mEq NaHCO3 per liter IVF)
    2. Urine pH > 8 desired to improve excretion
  4. Forced diuresis in patients with severe poisoning (concern for pulmonary edema)
  5. H-2 Blockers for severe overdose - prevention of gastritis, ulceration
  6. Dialysis for very high levels

References navigator

  1. Thibault GE. 1992. NEJM. 326(19):1272 abstract