Salicylate toxicity - Revision history

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:59:59Z

Add peer-reviewed references with PMIDs

← Older revision		Revision as of 09:59, 22 March 2026
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	**Uncouples oxidative phosphorylation → impaired aerobic metabolism, heat generation		**Uncouples oxidative phosphorylation → impaired aerobic metabolism, heat generation
	**Direct CNS stimulation of respiratory center → respiratory alkalosis (early)		**Direct CNS stimulation of respiratory center → respiratory alkalosis (early)
	**Accumulation of organic acids → anion gap metabolic acidosis (late)		**Accumulation of organic acids → anion gap metabolic acidosis (late)<ref>Palmer BF, Clegg DJ. Salicylate Toxicity. N Engl J Med. 2020;382(26):2544-2555. PMID 32579814</ref>
	**Inhibits Krebs cycle, disrupts lipid and amino acid metabolism		**Inhibits Krebs cycle, disrupts lipid and amino acid metabolism
	*Pharmacokinetics change in overdose:		*Pharmacokinetics change in overdose:

Danbot: Strip excess bold

2026-03-22T09:30:50Z

Strip excess bold

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Danbot: Major update: EXTRIP HD indications, intubation danger, CNS glucose deficiency, alkalinization protocol with K requirement, oil of wintergreen warning, zero-order kinetics, references with PMIDs

2026-03-21T19:51:40Z

Major update: EXTRIP HD indications, intubation danger, CNS glucose deficiency, alkalinization protocol with K requirement, oil of wintergreen warning, zero-order kinetics, references with PMIDs

Show changes

Danbot: Add MedicationDose SMW annotations (sodium bicarbonate, activated charcoal); dosing verified per ACMT guidelines

2026-03-20T16:27:31Z

Add MedicationDose SMW annotations (sodium bicarbonate, activated charcoal); dosing verified per ACMT guidelines

← Older revision		Revision as of 16:27, 20 March 2026
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	*Admit all patients who have ingested enteric-coated or extended-release preprarations		*Admit all patients who have ingested enteric-coated or extended-release preprarations


			<div style="display:none">
			<!-- SMW MedicationDose annotations for salicylate toxicity medications -->
			{{MedicationDose\|drug=Sodium bicarbonate\|dose=50-100 mEq IV bolus (pre-intubation); then continuous IV infusion titrated to blood pH 7.5-7.6 and urine pH 7.5-8\|route=IV/IV drip\|context=Alkalinization of plasma and urine\|indication=Salicylate toxicity\|notes=Indicated even with respiratory alkalosis; not a substitute for dialysis in severe cases}}
			{{MedicationDose\|drug=Activated charcoal\|dose=1 g/kg PO (max 50 g) initial; then 25 g PO q2h x3 or 50 g q4h x2 (multidose)\|route=PO\|context=GI decontamination (multidose effective)\|indication=Salicylate toxicity\|notes=Effectively absorbs ASA; multidose charcoal recommended if tolerated}}
			</div>
	==See Also==		==See Also==
	*[[Toxicology (Main)]]		*[[Toxicology (Main)]]

Benalexander: Minor edits for clarity, replaced broken Epocrates link, added reference to ACMT management guideline.

2025-07-30T14:50:33Z

Minor edits for clarity, replaced broken Epocrates link, added reference to ACMT management guideline.

← Older revision		Revision as of 14:50, 30 July 2025
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	==Background==		==Background==
			*Salicylates are commonly available in numerous over-the-counter products, and toxicity may occur from acute (intentional or accidental) and chronic ingestion.
	*Fatal dose:		*Fatal dose:
	**~10-30g by adult		**~10-30g by adult
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	*[[Aspirin]]		*[[Aspirin]]
	*Oil of Wintergreen		*Oil of Wintergreen
	**Oil of Wintergreen is very concentrated - 5mL contains ~~equivalent of 7.5g~~ of aspirin.<ref>[https://~~online~~.~~epocrates~~.com/u/~~29311129/Salicylate+poisoning Epocrates - Salicylate Poisoning]~~ Accessed ~~06/20/15~~.</ref>		**Oil of Wintergreen is very concentrated - 5mL contains approximately 7g of aspirin.<ref>Wintergreen. Drugs.com. https://www.drugs.com/npp/wintergreen.html. Published January 2, 2025. Accessed July 30, 2025.</ref>
	*[[Bismuth subsalicylate\|Pepto-Bismol]]		*[[Bismuth subsalicylate\|Pepto-Bismol]]
	*Wart removers		*Wart removers
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	**Un-ionized salicylate cross the placenta due to higher fetal pH, where it becomes ionized and accumulates in the fetus		**Un-ionized salicylate cross the placenta due to higher fetal pH, where it becomes ionized and accumulates in the fetus
	**Due to fetal inability to hyperventilate leads to worsening acidosis		**Due to fetal inability to hyperventilate leads to worsening acidosis
	**There can be displacement of bilirubin from protein binding sites allowing it to cross the blood brain barrier, which can lead to kernicterus.		**There can be displacement of bilirubin from protein binding sites allowing it to cross the blood brain barrier, which can lead to kernicterus.
	**Due to inhibition of prostaglandin synthesis, can lead to premature closure of the ductus arteriosus		**Due to inhibition of prostaglandin synthesis, can lead to premature closure of the ductus arteriosus

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	===Alkalinization of plasma and urine===		===Alkalinization of plasma and urine===
	*Not a substitute for dialysis in severe salicylism		*Not a substitute for dialysis in severe salicylism
	*Continuous IV infusion of [[sodium bicarbonate]] is indicated even in the presence of ~~mild~~ alkalemia from ~~the early~~ respiratory alkalosis ~~per~~ 2013 ~~ACMT guidelines~~		*Continuous IV infusion of [[sodium bicarbonate]] is indicated even in the presence of alkalemia from respiratory alkalosis<ref>American College of Medical Toxicology (ACMT). Guideline Document: Management Priorities in Salicylate Toxicity. https://www.acmt.net/wp-content/uploads/2022/06/PRS_130313_Management-Priorities-in-Salicylate-Toxicity.pdf. Published March, 2013. Accessed July 30, 2025.</ref>
	*~~Alkalemia from respiratory alkalosis~~ is ~~NOT a contraindication to NaHCO3 treatment~~		**Serum bicarbonate is still deficient
	*Mechanism		*Mechanism
	**Traps ASA in blood and in renal tubules		**Traps ASA in blood and in renal tubules

Rossdonaldson1: /* Video */

2024-04-17T20:10:17Z

Video

← Older revision		Revision as of 20:10, 17 April 2024
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	*[[Antidotes]]		*[[Antidotes]]
	*[[Aspirin]]		*[[Aspirin]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=_t2rFDnmxJw}}~~

	==References==		==References==

Elcatracho: /* Dialysis */

2021-02-01T19:20:13Z

Dialysis

← Older revision		Revision as of 19:20, 1 February 2021
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	*[[Seizure]]		*[[Seizure]]
	*[[Pulmonary edema]]		*[[Pulmonary edema]]
			*[[Coagulopathy]]
			*Inability to tolerate volume load from bicarb drip (e.g. [[CHF]])
	*New [[hypoxemia]]		*New [[hypoxemia]]
	*pH ≤7.20		*pH ≤7.20

Alexgrohmann: /* Pathophysiology */

2020-02-22T11:57:07Z

Pathophysiology

← Older revision		Revision as of 11:57, 22 February 2020
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	**Usually occurs in elderly		**Usually occurs in elderly
	**Due to increased pulmonary vascular permeability		**Due to increased pulmonary vascular permeability
			*[[Fetal Effects in pregnancy]]
			**Increased fetal morbidity and mortality
			**Un-ionized salicylate cross the placenta due to higher fetal pH, where it becomes ionized and accumulates in the fetus
			**Due to fetal inability to hyperventilate leads to worsening acidosis
			**There can be displacement of bilirubin from protein binding sites allowing it to cross the blood brain barrier, which can lead to kernicterus.
			**Due to inhibition of prostaglandin synthesis, can lead to premature closure of the ductus arteriosus

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Glucose */

2019-09-14T15:18:28Z

Glucose

← Older revision		Revision as of 15:18, 14 September 2019
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	===Glucose===		===Glucose===
	*Give D50 to altered patients regardless of serum glucose concentration		*Give [[dextrose\|D50]] to altered patients regardless of serum glucose concentration
	*Except for fluids used for initial resuscitation, all IVF should be D5W		*Except for fluids used for initial resuscitation, all IVF should be D5W
	**ASA toxicity impairs glucose metabolism		**ASA toxicity impairs glucose metabolism

ClaireLewis: /* Chronic Toxicity */

2019-09-14T15:17:34Z

Chronic Toxicity

← Older revision		Revision as of 15:17, 14 September 2019
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	===Chronic Toxicity===		===Chronic Toxicity===
	*Usually neurologic abnormalities, especially in elderly		*Usually neurologic abnormalities, especially in elderly
	**Agitation		**[[Agitation]]
	**Paranoia		**Paranoia
	**Memory deficits		**Memory deficits
	**Confusion		**[[Confusion]]
	**Stupor		**Stupor
	*Hyperventilation		*Hyperventilation
	*Tremor		*[[Tremor]]
	*Papilledema		*[[Papilledema]]
	*Higher morbidity (pulmonary edema, seizures, renal failure) and mortality rate compared with acute toxicity		*Higher morbidity ([[pulmonary edema]], [[seizures]], [[renal failure]]) and mortality rate compared with acute toxicity

	==Differential Diagnosis==		==Differential Diagnosis==