Pathophysiology

Interference with cellular metabolism (Uncouple oxidative phosphorylation) produces lactic acidosis and generates heat causing anion gap metabolic acidosis, hyperpyrexia, and hypoglycemia

1. Stimulate respiratory centers to cause hyperventilation causing respiratory alkalosis and increased insensible fluid losses

2. Salicylate exists more in the uncharged form at an acidic pH and is able to cross the blood-brain barrier causing CNS toxicity

3. Stimulation of chemoreceptors in the medulla causes nausea and vomiting

Toxic doses:

• Aspirin PO: 150 mg/kg or 6.5 grams

• Any PO oil of wintergreen exposure

• Significant dermal exposures & signs of toxicity

Examples of salicylates : Aspirin, Pepto-Bismol, Ben-gay, and wintergreen oil

Presentation

• Early: tinnitus, vertigo, tachypnea (respiratory alkalosis*), GI symptoms,

  • *Children almost never manifest a respiratory alkalosis and, when significantly poisoned, almost always progress right to acidemia secondary to metabolic acidosis.

• Late: metabolic acidosis, hypovolemia, hypokalemia, hypoglycemia

• Severe intoxication: fever, AMS, seizures, pulmonary edema

Diagnosis

Consult Poison Control: 1-800-222-1222

Management

References

1. Juurlink DN, Gosselin S, Kielstein JT, Ghannoum M, Lavergne V, Nolin TD, Hoffman RS; EXTRIP Workgroup. (2015) "Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup." Ann Emerg Med. 266(2):165-81. https://www.extrip-workgroup.org/salicylates