Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- unknown toxin ingestion or exposure
- confusion, disorientation, agitation
- coma
- convulsions
- fever, sweating, warm extremities, bounding pulses
- dyspnoea
- tachypnoea, hyperventilation, Kussmaul's respirations
- tinnitus and/or deafness
- nausea, vomiting, epigastric pain
- malaise and/or dizziness
- rales plus low oxygen saturation (signs of heart failure)
- deterioration in activities of daily living, non-focal neurological abnormalities
Other diagnostic factors
- volume depletion/dehydration
- skin rash
- ventricular arrhythmias and asystole
- haematemesis
- disseminated intravascular coagulation
Risk factors
- ingestion of ≥125 mg/kg salicylate
- ingestion of oil of wintergreen
- ingestion of bismuth subsalicylate
- history of self-harm or suicide attempt
- children aged ≤3 years and adults aged ≥70 years
Diagnostic investigations
1st investigations to order
- plasma salicylate concentration
- ABG
- serum electrolyte panel, urea and creatinine
- serum prothrombin time (PT), activated PTT, INR
- FBC
- capillary blood glucose
- ECG
Treatment algorithm
Contributors
Expert advisers
Johann Grundling, MBChB, FCEM, FFICM, EDICM, DFMS, DipMedTox, MMedTox, MSB, ERT, MEWI, MBA
Emergency Medicine Consultant
Royal London Hospital
Barts Health NHS Trust
Honorary senior lecturer
Queen Mary University
London
UK
Disclosures
JG declares that he has no competing interests.
James Kelly, MA (Oxon), MPhil, MA, MBBS, PGDME
Education Academy Fellow in Critical Care
Newham University Hospital
London
UK
Disclosures
JK declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
Chris Hoyte, MD
Medical Toxicology Fellowship Program Director
Rocky Mountain Poison and Drug Safety
Denver
Associate Professor
Department of Emergency Medicine
University of Colorado School of Medicine
Aurora
CO
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
Peer reviewers
Andreas Crede, MBChB, FCEM, MMed Emergency Medicine, PgDip Toxicology
Consultant
Emergency Department
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
Disclosures
AC declares that he has no competing interests.
Editors
Celia Pincus,
Section Editor, BMJ Best Practice
Disclosures
CP declares that she has no competing interests.
Tannaz Aliabadi-Oglesby,
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Susan Mayor,
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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