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Salicylate poisoning

Last reviewed: 5 Oct 2024
Last updated: 22 Mar 2024

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
  • ingestion of methyl salicylate (oil of wintergreen)
  • ingestion of bismuth subsalicylate
  • self-harm or suicide attempt
  • children ages 3 years or younger and adults 70 years or older
  • unknown toxin ingestion or exposure
  • abnormal behavior
  • nausea, vomiting, hematemesis, epigastric pain
  • fever and diaphoresis
  • shortness of breath
  • tachypnea, Kussmaul respirations
  • tinnitus and/or deafness
  • malaise and/or dizziness
  • movement disorders, asterixis, stupor
  • confusion and/or delirium (irritability, hallucinations)
  • coma and/or papilledema
  • seizures
  • rales plus low oxygen saturation
Full details

Other diagnostic factors

  • volume depletion
  • skin rash
Full details

Risk factors

  • ingestion of 150 mg/kg or more, or 6.5 g or more, of aspirin or aspirin equivalent
  • ingestion of methyl salicylate (oil of wintergreen)
  • ingestion of bismuth subsalicylate
  • history of self-harm or suicide attempt
  • children ages 3 years or younger and adults 70 years or older
Full details

Diagnostic tests

1st tests to order

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

Tests to consider

  • echocardiogram
  • head CT scan
  • EEG
Full details

Treatment algorithm

ACUTE

asymptomatic: without criteria for hospital referral

asymptomatic: with criteria for hospital referral

symptomatic

Contributors

Authors

Chris Hoyte, MD

Medical Toxicology Fellowship Program Director

Rocky Mountain Poison and Drug Safety

Denver

Professor

Department of Emergency Medicine

University of Colorado School of Medicine

Aurora

CO

Disclosures

CH declares that he has no competing interests.

Eric Lavonas, MD, MS

Attending Physician

Department of Emergency Medicine and Rocky Mountain Poison and Drug Safety

Denver Health

Denver

Professor

Department of Emergency Medicine

University of Colorado School of Medicine

Aurora

CO

Disclosures

EL is an author of a reference cited in this topic.

Acknowledgements

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

Peer reviewers

Colin A. Graham, MBChB, MPH, MD, FRCSEd, FRCSGlasg, FIMCRCSEd, FCCP, FCEM, FHKCEM, FHKAM

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.

Gerald F. O'Malley, DO

Director

Division of Research

Department of Emergency Medicine

Albert Einstein Medical Center

Philadelphia

PA

Disclosures

GFOM declares that he has no competing interests.

Paul Wax, MD

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 topic.

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