⚠️ Aspirin/Salicylate Toxicity is uncommon but potentially fatal. In severe cases 👉 plasma salicylate >700 mg/L (5.1 mmol/L) and/or severe metabolic acidosis. 💉 Haemodialysis is preferred (faster toxin clearance than haemofiltration).

🚨 Moderate/Severe Salicylate Toxicity (based on levels)
📊 Toxic >30 mg/dL; Severe >70 mg/dL or >500 mg/kg at 2 hrs. 🫁 ABC support; Oxygen if hypoxic; IV fluids for hypotension; admit CCU/ITU. 💊 Activated Charcoal (repeated doses if alert/airway protected, within 1–2 hrs). 🧴 Whole bowel irrigation (PEG) for very large overdoses. 💉 IV Sodium Bicarbonate infusion – aim urine pH >7.5 → ↑ renal clearance. ⚡ Correct hypokalaemia (essential for alkalinisation to work). 💤 Treat seizures with IV benzodiazepines; manage agitation/delirium. 🧪 Haemodialysis: definitive therapy in severe poisoning (esp. renal failure, severe acidosis, or >700 mg/L levels).

🚨 Moderate/Severe Salicylate Toxicity (based on levels)

📊 Toxic >30 mg/dL; Severe >70 mg/dL or >500 mg/kg at 2 hrs.
🫁 ABC support; Oxygen if hypoxic; IV fluids for hypotension; admit CCU/ITU.
💊 Activated Charcoal (repeated doses if alert/airway protected, within 1–2 hrs).
🧴 Whole bowel irrigation (PEG) for very large overdoses.
💉 IV Sodium Bicarbonate infusion – aim urine pH >7.5 → ↑ renal clearance.
⚡ Correct hypokalaemia (essential for alkalinisation to work).
💤 Treat seizures with IV benzodiazepines; manage agitation/delirium.
🧪 Haemodialysis: definitive therapy in severe poisoning (esp. renal failure, severe acidosis, or >700 mg/L levels).

📌 About

Salicylates = weak acids that uncouple oxidative phosphorylation → heat, lactic acidosis.
Cause mixed acid–base disturbance: early respiratory alkalosis → later metabolic acidosis.
Mortality remains high if untreated.

⚖️ Severity by Ingested Dose

Mild: >150 mg/kg
Severe: >500 mg/kg
Fatal: >700 mg/kg

🧬 Mechanisms of Toxicity

Uncouples oxidative phosphorylation → ↑ heat + metabolic acidosis 🌡️.
Stimulates medullary respiratory centre → hyperventilation + respiratory alkalosis 🫁.
Causes CNS hypoglycaemia even if blood glucose is normal → delirium, seizures 🧠.
Electrolyte losses (K⁺, HCO₃⁻) → worsen acidosis.

🩺 Clinical Features

Hyperventilation, tinnitus, deafness, N&V 🤢.
Agitation, delirium, confusion, coma 🧠.
Vasodilation, sweating, fever 🌡️.

⚠️ Complications

Respiratory alkalosis → early.
Metabolic acidosis (high AG lactic acidosis) → later/severe.
Respiratory acidosis suggests co-ingestion of CNS depressant.
Hyperthermia → marker of severe poisoning.
Other: pulmonary oedema, cerebral oedema, renal failure.

🔬 Investigations

FBC, U&E, LFTs, salicylate + paracetamol levels.
ABG/VBG: mixed alkalosis + metabolic acidosis.
Severe = plasma salicylate >700 mg/L.
ECG, CXR if respiratory involvement.

💊 Management

ABC resus + O₂ + IV fluids.
Activated charcoal (repeated if ongoing absorption).
IV Sodium Bicarbonate infusion (with K⁺ correction) → aim urine pH 7.5–8.5.
Whole bowel irrigation for massive overdose.
Dialysis indicated if:
- Plasma salicylate >700 mg/L 📊.
- Severe acidosis or hypotension despite support.
- End-organ injury (seizures, pulmonary oedema, AKI, cerebral oedema).
❌ Avoid gastric lavage (rare, not recommended).

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Aspirin/Salicylate Toxicity