Aspirin and other salicylate poisoning

[Ernesto]

Salicylate poisoning can cause vomiting, tinnitus, confusion, hyperthermia, respiratory alkalosis, metabolic acidosis, and multiple organ failure. Diagnosis is clinical, supplemented by measurement of the anion gap, arterial blood gases, and serum salicylate levels. Treatment is with activated charcoal and alkaline diuresis or hemodialysis.

(See also General Principles of Poisoning.)

Acute ingestion of gt; 150 mg/kg can cause severe toxicity. Salicylate tablets may form bezoars, prolonging absorption and toxicity. Chronic toxicity can occur after several days or more of high therapeutic doses; it is common, often undiagnosed, and often more serious than acute toxicity. Chronic toxicity tends to occur in elderly patients.

The most concentrated and toxic form of salicylate is oil of wintergreen (methyl salicylate, a component of some liniments and solutions used in hot vaporizers); ingestion of lt; 5 mL can kill a young child. Any exposure should be considered serious. Bismuth subsalicylate (8.7 mg salicylate/mL) is another potentially unexpected source of large amounts of salicylate.