There is no antidote for salicylate poisoning. Initial treatment of an overdose involves resuscitation measures such as maintaining an adequate airway and adequate circulation followed by gastric decontamination by administering activated charcoal, which adsorbs the salicylate in the gastrointestinal tract.
What happens if you overdose on salicylates?
Salicylate toxicity is a medical emergency. Intentional ingestion or accidental overdose can cause severe metabolic derangements, making treatment difficult. Co-ingestion of other medications can further complicate management. Salicylates are widely available over the counter medications.
What is the treatment for salicylate toxicity in the emergency department?
Salicylate Toxicity Treatment & Management 1 Approach Considerations. Salicylate toxicity continues to be seen in the emergency department as... 2 Triage Care. They published guidelines on triage care of these patients, discussed below. 3 Emergency Department Management. Therapeutic objectives include cardiopulmonary stabilization,...
How effective is dialysis in the treatment of salicylate intoxication?
Hemodialysis is extremely effective in salicylate intoxication. In severe salicylate intoxication, dialysis may be life-saving. Dialysis often takes several hours to set up. Therefore, for patients who are deteriorating clinically, it is often wise to initiate dialysis early.
How long does it take for salicylate levels to drop?
(2) In chronic intoxication the serum levels may under-estimate the severity of the intoxication, because salicylate has already accumulated in the brain. (3) Falling salicylate level may reflect drug entering the tissues, so this isn't necessarily an optimistic finding. Levels usually peak around six hours after ingestion.
What is the antidote for salicylate?
No specific antidote for salicylate poisoning is available. Therapy is focused on immediate resuscitation, correction of volume depletion and metabolic derangement, GI tract decontamination, and reduction of the body's salicylate burden. Early consultation with a medical toxicologist is prudent.
How do you remove salicylates?
Hemodialysis is the most efficient method of removing salicylates from the blood. Dialysis is the treatment of choice in salicylate-intoxicated patients who have severe renal, hepatic, or cardiovascular disorders, uncorrectable acidosis, comatose, seizing, or are unresponsive to other methods of treatment.
How do you counteract too much aspirin?
Some of the potential treatment options for aspirin overdose include:Gastric emptying or lavage (stomach pumping)Laxative.Activated charcoal (if less than 3 hours have passed since the overdose occurred)Breathing support such as oxygen, breathing tube (intubation) and a breathing machine (ventilator)More items...•
How is salicylate treated?
Initial treatment should include the use of oral activated charcoal, especially if the patient presents within 1 hour of ingestion. Activated charcoal can limit further gut absorption by binding to the available salicylates.
How long does it take for salicylates to get out of your system?
Salicylates are generally absorbed quickly through the gastrointestinal tract. The elimination half-life is generally between 3 and 12 hours at therapeutic doses, but this can increase unpredictably up to 30 hours in the setting of an overdose.
What are the signs and symptoms of salicylate toxicity?
Acute intoxication presents with classical symptoms of vomiting, tinnitus, hyperventilation, respiratory alkalosis and metabolic acidosis. Salicylate is found in a number of oral and topical preparations including: Medications - Aspirin and aspirin containing drug compounds.
What organ is damaged by taking too much aspirin?
Symptoms of Aspirin Poisoning Severe disease can cause acute kidney injury... read more ), kidney failure. Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood.
What happens to your body when you overdose on paracetamol?
You may feel sick, vomit or have abdominal (tummy) pain after taking too much paracetamol, but often there are no obvious symptoms at first. It is important to seek medical advice if you have a suspected paracetamol overdose, even if you feel well initially.
What drugs cause salicylate poisoning?
Salicylate poisoning is potentially fatal. Salicylates are present in aspirin medications and in high concentrations of oil of wintergreen (methyl salicylate: one teaspoon = 7 g of salicylate).
What are the symptoms of salicylate toxicity?
These can include confusion, slurred speech, and hallucinations. Tachypnea is more pronounced and is accompanied by tachycardia and orthostatic hypotension.
How long does it take for salicylate to cause nausea?
In an acute salicylate overdose, the onset of symptoms will occur within 3 to 8 hours. The severity of symptoms is dependent on the amount ingested. For mild ingestions (salicylate levels 40 to 80 mg/dL) nausea, vomiting, and generalized abdominal pain are common. Tachypnea is usually present.
What is salicylate toxicology?
Salicylate toxicity is a medical emergency. Intentional ingestion or accidental overdose can cause severe metabolic derangements, making treatment difficult. Co-ingestion of other medications can further complicate management. Salicylates are widely available over the counter medications. They are commonly used for their analgesic, antipyretic, and anti-thrombotic properties, and toxicity can occur due to acute ingestion or from chronic ingestion. Salicylates can be compounded into formulations with other classes of medications including narcotics, antihistamines, and anticholinergic medications. This can complicate management. This activity illustrates the evaluation and treatment of salicylate toxicity and reviews the role of interprofessional team members in managing patients affected by this condition.
What are salicylates used for?
Salicylates are widely available over the counter medications. They are commonly used for their analgesic, antipyretic, and anti-thrombotic properties. Toxicity can occur due to acute ingestion or from chronic ingestions that result in an increased serum concentration. Salicylates can be compounded into formulations with other classes of medications including narcotics, antihistamines, and anticholinergic medications. This can complicate management. [3][4]
How many deaths from salicylates in 2011?
Epidemiology. In 2011 there were 30,000 cases of salicylate toxicity in the United States with 39 deaths. Overall the mortality was less than 0.01%; however, this increased to 15% for patients with severe toxicity. Complications increased when the diagnosis was not made upon initial evaluation.
What should be checked for salicylates?
A salicylate level should be checked on all patients with a concern for salicylate toxicity. Serial levels are recommended as absorption is widely variable and will impact treatment. Acetaminophen levels should also be checked as confusion about what substance was ingested may occur. Electrolytes, including calcium and magnesium, ABG, LFTs, CBC, lactate, and coagulation studies should be obtained. An ECG to evaluate for dysrhythmias should be obtained. Consider a CT head if the patient has altered mental status. Serial ABGs and salicylate levels should be obtained until levels clearly begin to downtrend and pH stabilizes.
How does the liver metabolize salicylates?
The liver metabolizes salicylates by first-order elimination, and the inactive metabolites are then excreted in the urine. With increased salicylate levels, these pathways become saturated resulting in zero order elimination. Elimination is further delayed in patients with underlying renal and liver disease.
How do salicylates affect the body?
Salicylates disrupt aerobic metabolism by uncoupling oxidative phosphorylation, leading to lactate and ketone accumulation. At lower serum pH, more salicylic acid exists in an uncharged state, allowing more distribution into tissues. Metabolic disruption causes neuroglycopenia (depletion of glucose in CNS).
Why do salicylate concentrations decline?
Failure to recognize worsening toxicity – salicylate concentrations decline not only because of elimination but also due to increasing distribution into tissues. A falling ASA level with worsening acidosis is concerning for severe toxicity.
How long does it take for charcoal to decontaminate?
Decontamination: activated charcoal within 6 hours of ingestion is indicated in patients at low risk of aspiration. The window for charcoal administration is extended as absorption is frequently prolonged in salicylate toxicity due to salicylate-induced pylorospasm and bezoar formation.
What happens to salicylic acid at lower pH?
At lower serum pH, more salicylic acid exists in an uncharged state, allowing more distribution into tissues.
Is ASA toxic?
Chronic ASA toxicity can be difficult to diagnose and treat.
Is chronic toxicity more likely in elderly patients with dehydration and/or renal injury?
Chronic toxicity is more likely in elderly patients with dehydration and/or renal injury.
Can chronic toxicity be caused by dehydration?
Chronic toxicity can result from therapeutic dosing if dehydration or renal injury is present.
How long does salicylate poisoning last?
Key points. The symptoms of acute salicylate poisoning may be minimal initially with severe toxicity not evident until 6-12 hours. There is a poor correlation between salicylate concentration and toxicity and deterioration may still occur with falling serum concentrations due to rising CNS concentration.
What are the symptoms of acute intoxication?
Acute intoxication presents with classical symptoms of vomiting, tinnitus, hyperventilation, respiratory alkalosis and metabolic acidosis. Salicylate is found in a number of oral and topical preparations including:
Can hypokalaemia cause alkalinization?
Urinary alkalinisation is not possible in the presence of hypokalaemia. Urinary alkalinisation will also produce urinary potassium loss. Therefore potassium must be replaced via intravenous administration to maintain a mid-range concentration.
How long before paralysis should you give bicarbonate?
This should be done >5-10 minutes before paralysis, so that the patient has time to blow off excess CO2 from the infused bicarbonate.
Why do serum levels underestimate the severity of intoxication?
In chronic intoxication the serum levels may underestimate the severity of the intoxication, because salicylate has already accumulated in the brain.
How long does it take for dialysis to start?
Dialysis often takes several hours to set up. Therefore, for patients who are deteriorating clinically, it is often wise to initiate dialysis early. The risks of performing hemodialysis early (under controlled settings) are far lower than the risks of a severe salicylate intoxication (ICU mortality of 15%!).
Why is acidemia scary?
Regardless of the etiology, this is very scary because these patients aren't defending their pH. Acidemia promotes entry of salicylate into the brain, worsening the intoxication. This creates the possibility of a death spiral involving hypercapnia, acidosis, and CNS dysfunction:
Why is intermittent hemodialysis preferred over continuous renal replacement?
Intermittent hemodialysis is preferred over continuous renal replacement, because it is more efficient.
What happens if you take bicarbonate?
If sufficient bicarbonate is administered, the kidneys should eventually excrete it leading to urinary alkalinization.
How long should you wait to do labs after discontinuing alkalinization?
Following discontinuation of alkalinization, it may be reasonable to follow labs for 2-4 additional hours to ensure that acidosis doesn't recur (especially in chronic toxicity).
Toxicity
- Salicylate toxicity continues to be seen in the emergency department as a result of unintentional ingestions or suicide attempts. A high index of suspicion is necessary, with prompt recognition of clinical signs and symptoms of salicylate poisoning, such as tinnitus, hyperventilation, tachycardia, and metabolic acidosis. [3] Early treatment can prevent organ damage and death.
Treatment
- Principles of treatment include stabilizing the ABCs as necessary, limiting absorption, enhancing elimination, correcting metabolic abnormalities, and providing supportive care. No specific antidote is available for salicylates.
Diagnosis
- Although serial serum salicylate concentrations determination offers valuable information regarding the effectiveness of the treatment implemented, assessment of these levels alone is not a substitute for clinical evaluation of the patient. When considering treatment options, the final decision should be individualized according to the clinical status of the patient and should …
Management
- Optimal management of a salicylate poisoning depends on whether the exposure is acute or chronic. Gastric lavage and activated charcoal are useful for acute ingestions but not for cases of chronic salicylism. Patients with chronic, rather than acute, ingestions of salicylates are more likely to develop toxicity, especially of the CNS, and require i...
Interactions
- Salicylate poisoning has been shown to cause metabolic derangements with significant inhibition of Krebs cycle enzymes. [19] It also uncouples oxidative phosphorylation. Because of impaired glucose homeostasis, CNS glucose supply is sometimes lowered, which results in hypoglycorrhachia and delirium, even when serum glucose concentration is normal. Glucose bol…
Prognosis
- Chronic salicylism may be insidious; elderly individuals may consume an increasing amount over several days to alleviate arthralgias, subsequently becoming confused, as salicylate pharmacokinetics change at higher concentrations. This may lead to a vicious cycle of increased salicylate consumption and increased confusion. Similar scenarios occur in persons with underl…
Risks
- Patients with accidental ingestions of less than 150 mg/kg and no signs of toxicity can be discharged 6 hours post ingestion. Arrange a follow-up for these patients in 24 hours. The importance of follow-up is illustrated by the case report of a 17-year-old girl who had ingested 126-mg/kg of non-enteric coated aspirin and had nontoxic salicylate concentrations 3.9 hours p…
Contraindications
- Patients with intentional ingestions should have a psychiatric consultation prior to discharge in the emergency department or on the ward.