Pearls for treatment of salicylate toxicity:
1. Salicylate toxicity typically causes a mixed acid base picture: respiratory alkalosis PLUS elevated anion gap metabolic acidosis. In addition to direct stimulation of the respiratory center, patients also hyperventilate to blow off extra CO2 from their severe metabolic acidosis. If you do wind up intubating a patient with severe salicylate toxicity, remember to continue to hyperventilate them on the ventilator to avoid lethal acidemia.
2. Hemodialysis for most severe ingestions. Indications for hemodialysis in acute salicylate toxicity:
a. Serum level > 120 mg/dL acutely or > 100 mg/dL (6 hours post ingestion)
b. Refractory acidosis
c. Coma or seizures
d. Noncardiogenic pulmonary edema
e. Volume overload
f. Renal failure
From Waseem, Muhammed, et al. Salicylate Toxicity Treatment & Management. Medscape. Available at: http://emedicine.medscape.com/article/1009987-treatment#aw2aab6b6b4. Accessed Dec. 22, 2011.
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