Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • ingestion of 150 mg/kg or more, or 6.5 g or more, of aspirin or aspirin-equivalent
  • oil of wintergreen ingestion
  • unknown toxin ingestion or exposure
  • self-harm or suicide attempt
  • abnormal behaviour
  • children aged 3 years or younger and adults aged 70 years or older
  • nausea, vomiting, haematemesis, epigastric pain
  • fever and diaphoresis
  • shortness of breath
  • tachypnoea, hyperpnoea, Kussmaul's respirations
  • tinnitus and/or deafness
  • malaise and/or dizziness
  • movement disorders, asterixis, stupor
  • confusion and/or delirium (irritability, hallucinations)
  • coma and/or papilloedema
  • seizures
  • rales plus low oxygen saturation

Other diagnostic factors

  • volume depletion
  • skin rash

Risk factors

  • ingestion of 150 mg/kg or more, or 6.5 g or more, of aspirin or aspirin-equivalent
  • ingestion of oil of wintergreen
  • ingestion of bismuth subsalicylate
  • hx of self-harm or suicide attempt
  • children aged 3 years or younger and adults 70 years or older

Diagnostic investigations

1st investigations to order

  • ABG
  • serum electrolyte panel
  • serum salicylate level
  • serum urea and creatinine
  • serum ketones
  • blood glucose
  • FBC
  • serum LFTs
  • serum PT, activated PTT, INR
  • toxicology screen
  • chest x-ray
  • ECG
Full details

Investigations to consider

  • echocardiogram
  • head CT scan
  • EEG
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Medical Toxicology Fellow

Rocky Mountain Poison and Drug Center

Denver

CO

Disclosures

CH declares that he has no competing interests.

Assistant Professor

Department of Emergency Medicine

University of Colorado School of Medicine

Denver

CO

Disclosures

EL declares that he has no competing interests.

Dr Chris Hoyte and Dr Eric Lavonas would like to gratefully acknowledge Dr Kathryn A. Koch, a previous contributor to this monograph. KAK declares that she has no competing interests.

Peer reviewers VIEW ALL

Editor

European Journal of Emergency Medicine

Professor of Emergency Medicine

Chinese University of Hong Kong

Hong Kong

People's Republic of China

Disclosures

CAG is the editor of the European Journal of Emergency Medicine and receives an annual honorarium from Wolters Kluwer Health, the journal's publishers.

Director

Division of Research

Department of Emergency Medicine

Albert Einstein Medical Center

Philadelphia

PA

Disclosures

GFOM declares that he has no competing interests.

Clinical Professor of Surgery (Emergency Medicine)

University of Texas Southwestern Medical Center

Dallas

TX

Disclosures

PW is an author of a reference cited in this monograph.

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