eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Toxicology

Toxicity, Salicylate: Follow-up

Author: Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Coauthor(s): Muhammad Aslam, MD, Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston; Joel R Gernsheimer, MD, Program Director, Department Emergency Medicine, Lincoln Medical and Mental Health Center
Contributor Information and Disclosures

Updated: Feb 12, 2008

Follow-up

Further Inpatient Care

  • A patient may be discharged following adequate GI tract decontamination with activated charcoal if clinical improvement is progressive, acid-base disturbance is not significant, and serial decrease in serum salicylate levels towards the therapeutic range is documented. If any doubt is noted, the patient should be admitted to an appropriate facility.
  • If the ingestion was a suicide attempt, ensure adequate psychiatric and social evaluation before discharge.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to confirm units of measurement may lead to confusion. Always confirm the units of measurement. Laboratories vary in reported salicylate concentrations by using milligram per deciliter or milligrams per liter, which differ by a factor of 10.
  • Immediately begin therapy in symptomatic patients. Do not wait for the salicylate levels to return from the laboratory.
  • Monitor serum electrolytes, calcium, and glucose levels, ABG, urine pH and specific gravity, and coagulation studies.
  • Patients with severe salicylate intoxication are usually volume depleted and have acid-base disturbances.
  • Dehydration or hypokalemia can limit the effectiveness of urine alkalization. Fluid replacement of volume deficits should be undertaken while preparations are made for other measures. Potassium (40 mEq/L) should be administered after adequate urine output has been established.
  • A glucose-containing crystalloid should be used in most patients because hypoglycemia has been implicated in the pathophysiology of salicylate-induced CNS injury.
  • Patients with salicylate poisoning may have low glucose concentrations in the CSF and CNS despite serum glucose concentrations within the reference range.
  • Failure to administer activated charcoal because the ingestion occurred more than one hour prior to emergency department visit is a potential pitfall.
  • Symptomatic patients require alkaline diuresis.
  • Critically ill patients who have sustained salicylic poisoning require hemodialysis.
 


More on Toxicity, Salicylate

Overview: Toxicity, Salicylate
Differential Diagnoses & Workup: Toxicity, Salicylate
Treatment & Medication: Toxicity, Salicylate
Follow-up: Toxicity, Salicylate
References
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References

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Further Reading

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Keywords

salicylate toxicity, salicylic toxicity, aspirin, oil of wintergreen, salicylic acid, salicylate toxicity, salicylate poisoning, salicylate intoxication, aspirin overdose, analgesic overdose, tinnitus, bedside ferric chloride testing, activated charcoal, methyl salicylate, Pepto-Bismol, Ben-Gay, respiratory alkalosis, ketosis, wide anion-gap metabolic acidosis, noncardiogenic pulmonary edema, hypoxia, dehydration, tinnitus, cerebral edema, hyperthermia, pylorospasm, hepatitis, Reye syndrome, hypoprothrombinemia, rhabdomyolysis

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Contributor Information and Disclosures

Author

Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Muhammad Waseem, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Muhammad Aslam, MD, Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston
Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Medical Association, Massachusetts Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Joel R Gernsheimer, MD, Program Director, Department Emergency Medicine, Lincoln Medical and Mental Health Center
Joel R Gernsheimer, MD is a member of the following medical societies: American College of Emergency Physicians, American Geriatrics Society, American Heart Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael E Mullins, MD, Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine
Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians
Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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