240. A not so nice ring to it: An Approach to Salicylate toxicity
Jun 10, 2024
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Dr. Bonisteel, Dr. Laird, Dr. Howes, and Sapriya Birk discuss the history, pharmacology, and clinical management of Salicylate Toxicity. Topics include the origins of salicylates, discovery of aspirin, toxic effects, criteria for dialysis, altered mental status, severe acidosis, acute kidney injury, and a case of tinnitus after ingestion.
Salicylate toxicity manifests through various symptoms impacting multiple body systems.
Diagnosis and treatment of salicylate toxicity involve specific clinical assessments and supportive measures.
Deep dives
Evolution of Salicylates from Ancient Egypt to Modern Medicine
Salicylates derived from willow bark, with roots dating back to ancient Egypt, have been utilized for their pain-relieving and anti-inflammatory properties. The discovery of acetosicylic acid, known as aspirin, in the 1890s revolutionized salicylate usage due to its reduced irritant effects on the stomach, making it a widely preferred medication since then.
Pathophysiology and Toxic Effects of Salicylate Overdose
Salicylates, weak acids primarily absorbed in acidic environments like the stomach, exert their effects by blocking COX pathways, reducing inflammation, and impacting platelet aggregation. Toxic effects of salicylate overdose include metabolic acidosis, neuroglucopenia, respiratory issues from the brain stem, gastrointestinal disturbances like nausea and vomiting, and damage to various body systems such as kidneys and cochlear hair cells.
Diagnosis and Treatment Strategies for Salicylate Toxicity
Diagnosing salicylate toxicity involves assessing clinical features like tinnitus, fever, gastrointestinal symptoms, and mental status alterations, alongside specific investigations like serum levels and blood gas analysis. Treatment includes supportive measures like oxygen therapy and fluid resuscitation, gastrointestinal decontamination with activated charcoal, alkalinization of serum and urine, continuous monitoring of electrolytes, and potential hemodialysis for severe cases.
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Understanding the History, Pharmacology, and Clinical Management of Salicylate Toxicity
Written by Dr. Isaac Bonisteel (Internal Medicine). Reviewed by Dr Phil Laird (General Internal Medicine and Critical Care) and Dr. Dan Howes (Critical Care). Infographic by Sapriya Birk (Medical Student)