o More than 200 products contain salicylates. Bismuth subsalicylate is an ingredient in Pepto-Bismol. Oil of wintergreen (methyl salicylate) used in BENGAY is highly toxic.
o Salicylates increase ATP production which leads to metabolic acidosis.
o Acute toxicity
§ Mild toxicity at 150 mg/kg – nausea, vomiting, dizziness, and tinnitus.
§ Moderate at 250 mg/kg – tachypnea, hyperpyrexia, sweating, agitation.
§ Severe at 500 mg/kg – metabolic acidosis, hypotension, renal failure, seizures.
o Chronic toxicity at 100 mg/kg per day for 2 or more days – confusion, hallucinations, GI irritation leads to nausea, vomiting, and hematemesis, hypoglycemia, renal failure.
o DX: Obtain a serum salicylate level initially and every 4 hours until the concentration has peaked (may be 12-18 hours for enteric-coated tablets).
o TX: Activated charcoal initially and repeated, gastric lavage only if patient presents within 1 hour and > 500 mg/kg. Urinary alkalization by adding 100 mEq of sodium bicarbonate to each liter of IVF and infusing at 200-300 ml/hr. Hemodialysis for severe toxicity, and benzodiazepines to treat seizure activity.