Differentiating between Acute and Chronic Salicylate Toxicity

Show Notes

Take Home Points

• Always consider salicylate toxicity:
  • In patients with tachypnea, hyperpnea, AMS and clear lungs
  • In the presence of an anion gap metabolic acidosis with a respiratory alkalosis
• Treat salicylate toxicity by alkalinizing the blood and urine to increase excretion
• Avoid intubation until absolutely necessary. If you do have to intubate, minimize apneic time and consider awake intubation and nake sure your ventilator settings match the patient’s necessary high minute ventilation
• Think about chronic salicylate toxicity in unexplained altered mental status, tachypnea or metabolic acidosis in elderly
• Know indications for hemodialysis in salicylate toxic patients

Read More

• REBEL EM: Salicylate Toxicity
• LITFL: Salicylates
• Wiki EM: Salicylate Toxicity
• Rebel EM: Acute Salicylate Toxicity, Mechanical Ventilation, and Hemodialysis
• Mosier JM et al. The Physiologically Difficult Airway. The western journal of emergency medicine. 16(7):1109-17. 2015. PMID: 26759664