Salicylates Toxicity


Mechanism/Toxicity

Pathophysiology of Salicylate Toxicity:
  • Local gastric irritation
  • Stimulation of the chemoreceptor zone
  • Stimulation of medullary respiratory center
  • Stimulation of skeletal muscle metabolism
  • Uncoupling of oxidative phosphorylation
  • Enhancement of lipolysis
  • Inhibition of Krebs cycle
  • Increased vascular permeability
  • Mobilization of glycogen stores
  • Inhibition of gluconeogenesis
  • Reversible ototoxicity

Symptoms/Exam

Severity Grading of Salicylate Toxicity in Adults
  Mild Moderate Severe
Acute ingestion (dose) <150 mg/kg 150–300 mg/kg >300 mg/kg
End-organ toxicity Tinnitus Tachypnea Abnormal mental status
Hearing loss Hyperpyrexia Seizures
Dizziness Diaphoresis Acute lung injury
Nausea/
Vomiting
Ataxia Renal failure
Anxiety Cardiac arrhythmias
Shock


Diagnosis

Treatment

The goal of treatment is to keep salicylate in the ionized form, thereby inhibiting its movement into the brain and tissues and enhancing its urinary excretion.

Treatment of Salicylate Toxicity:
GI decontamination Gastric lavage
Activated charcoal (single dose)
Sorbitol (single dose)
Whole-bowel irrigation: large ingestion of modified-release or enteric-coated formulations
Fluid and electrolyte replacement Normal saline IV infusion
Potassium replacement
Ion trapping Urinary alkalinization with sodium bicarbonate infusion
Extracoporeal elimination techniques Hemodialysis
Hemofiltration
Hemodiafiltration


Disposition