Salicylates (Aspirin) Toxicity

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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.

• Salicylates increase ATP production which leads to metabolic acidosis.

• 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.

• 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.

• 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).

• Initial Management:

  • Activated charcoal initially and repeated, gastric lavage only if patient presents within 1 hour and > 500 mg/kg.

  • Systemic/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.

  • Benzodiazepines to treat seizure activity.