From the Guidelines
Treatment for salicylate poisoning should prioritize extracorporeal treatment, such as hemodialysis, in patients with severe poisoning, including those with altered mental status, acute respiratory distress syndrome, or high salicylate concentrations (>7.2 mmol/L [100 mg/dL]) 1.
Key Considerations
- Extracorporeal treatment is recommended for patients with severe salicylate poisoning, as it can effectively remove the toxin from the body 1.
- Hemodialysis is the preferred modality for extracorporeal treatment, but hemoperfusion and continuous renal replacement therapies are acceptable alternatives if hemodialysis is unavailable 1.
- The decision to initiate extracorporeal treatment should be based on the severity of symptoms, salicylate concentration, and the patient's overall clinical condition, including impaired kidney function 1.
Treatment Approach
- Activated charcoal may be administered if the patient presents within 1-2 hours of ingestion to reduce absorption.
- Intravenous fluids and urinary alkalinization using sodium bicarbonate are essential to correct dehydration, electrolyte imbalances, and enhance salicylate excretion.
- Supportive care, including correcting hypoglycemia, managing hyperthermia, and addressing respiratory issues, is crucial throughout treatment.
- Careful monitoring of vital signs, mental status, electrolytes, and salicylate levels is necessary to prevent complications and adjust treatment as needed.
Severity-Based Treatment
- Patients with altered mental status, acute respiratory distress syndrome, or high salicylate concentrations (>7.2 mmol/L [100 mg/dL]) should receive extracorporeal treatment regardless of other factors 1.
- Lower salicylate concentration thresholds may be applied for patients with impaired kidney function, and extracorporeal treatment may be considered for patients with severe acidemia (pH 7.20) 1.
From the Research
Treatment of Salicylate Poisoning
The treatment of salicylate poisoning is based on the prevention of further absorption and enhancement of excretion of already absorbed drug. Some of the key treatment options include:
- Administration of activated charcoal to prevent further absorption of the drug 2, 3
- Alkalinization with sodium bicarbonate to counteract metabolic acidosis and enhance renal excretion of the drug 2, 3
- Multiple-dose activated charcoal to enhance elimination of absorbed drug 3
- Hemodialysis or hemoperfusion in severe cases where other treatment options fail 2
Management of Salicylate Exposure
The management of salicylate exposure involves a systematic approach to diagnosing and treating patients. Some of the key considerations include:
- Evaluation of the patient's symptoms and medical history to determine the severity of the exposure 4, 5
- Administration of activated charcoal in acute ingestions if available and no contraindications are present 4
- Referral to an emergency department for patients with severe symptoms or high-risk exposures 4, 5
- Monitoring of patients for the onset of symptoms and provision of follow-up care as needed 4, 5
Clinical Considerations
Salicylate toxicity can be difficult to diagnose, especially in cases where the patient does not provide a history of ingestion. Some of the key clinical considerations include:
- Salicylates should be considered in the differential diagnosis of patients with acid-base abnormalities and neurologic symptoms 6
- Prompt recognition and treatment of salicylate toxicity are critical to preventing morbidity and mortality 6
- Delayed diagnosis can result in increased morbidity and mortality, particularly in the elderly 6