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Salicylate toxicity is the great toxicologic mimicker!!!

Step 1: When to Suspect Salicylate Overdose

  • Signs of CNS stimulation
    • Tachypnea
    • Hyperthermia
    • Altered mental status
  • Signs of GI irritation
    • Nausea/Vomiting
    • Abdominal pain
  • Common “mimicker”
    • Sepsis
    • Acute abdomen

Step 2: Testing Plan

  • Electrolyte panel
    • Anion gap metabolic acidosis
      • Sodium – Chloride – Bicarb
        • Normal anion gap (AG) is <10
        • Caused by salicylic acid and lactic acid
  • Blood gas
    • Mixed respiratory ALKALOSIS and metabolic ACIDOSIS

Step 3: Obtain Serum Salicylate Level

Step 4: Treatment Plan

  • Mild salicylate toxicity
    • Alkalinize urine with sodium bicarbonate (NaHCO3) drip
  • Severe salicylate toxicity
    • Dialysis

Additional Reading