The following document highlights clinically important issues that both demand attention in the salicylate-poisoned patient and suggest avenues for future clinical research.
#ANTIDOTE FOR ASPIRIN SERIES#
While an abundance of case reports, case series and textbook chapters serve to identify critical issues and provide recommendations for therapy, there have not been direct comparisons of specific treatment regimens. Once the diagnosis of salicylate toxicity is seriously considered, treatment should begin promptly. Serum salicylate concentrations should be interpreted in the context of the acuity of the exposure and the overall clinical condition.Significant toxicity with chronic salicylate exposure can occur at relatively low serum concentrations. Acid-base disturbances including respiratory alkalosis, elevated anion gap metabolic acidosis, and mixed abnormalities are common. Volume resuscitation should be addressed early in the course. Salicylate-poisoned patients are almost universally volume depleted at the time of presentation to medical care (as much as 4-6 L in most symptomatic adults) from both sensible (e.g., vomiting and natriuresis) and insensible (e.g., fever, increased respiratory losses) losses. Patients with salicylate toxicity may have involvement of multiple organ systems including particularly the central nervous system (cerebral edema, coma, agitation, tinnitus, seizures), the pulmonary system (hyperventilation/tachypnea, acute lung injury), and the gastrointestinal system (nausea, vomiting). Salicylates are found in over-the-counter medications including aspirin, bismuth subsalicylate, effervescent antacids, ointments, liniments and oil of wintergreen (methyl salicylate) and alternative medication products (e.g., willow bark) as well as numerous prescription medications. Salicylate toxicity is a complex problem that may develop with either acute or chronic exposure to salicylates.
It is not intended as a clinical guideline or substitute for clinical consultation with a medical toxicologist and a nephrologist.
This document identifies critical management priorities for the salicylate-poisoned patient.
While individual practitioners may differ, this is the position of the College at the time written, after a review of the issue and pertinent literature.
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