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
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 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
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
Tests to consider
- echocardiogram
- head CT scan
- EEG
Treatment algorithm
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.
Differentials
- Diabetic ketoacidosis
- Dementia
- Pneumonia
More DifferentialsGuidelines
- Salicylates poisoning
- Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management
More GuidelinesCalculators
Anion Gap
More Calculators- Log in or subscribe to access all of BMJ Best Practice
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