Last reviewed: 5 Nov 2020
Last updated: 09 Nov 2020

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
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

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.

Education Academy Fellow in Critical Care

Newham University Hospital

London 

UK

Disclosures

JK declares that he has no competing interests.

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 reviewersVIEW ALL

Consultant

Emergency Department

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield 

UK

Disclosures

AC declares that he has no competing interests.

Section Editor, BMJ Best Practice

Disclosures

CP declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

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.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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