eMedicine Specialties > Emergency Medicine > Toxicology
Toxicity, Salicylate: Follow-up
Updated: Jul 11, 2008
Follow-up
Further Inpatient Care
- Admit patients with major signs and symptoms (eg, neurological, cardiopulmonary, metabolic) to an intensive care unit under the care of a medical toxicologist, if available. Consult psychiatric service personnel for patients with intentional overdose.
- Admit patients with minor signs and symptoms (eg, tinnitus, nausea) to an extended care observational unit or medical floor.
- Admit the following patients, regardless of salicylate levels:
- Infants and elderly persons
- Individuals with chronic salicylism
- Those with ingestions of sustained-release products
Further Outpatient Care
- Patients with accidental ingestions of less than 150 mg/kg and no signs of toxicity can be discharged after 6 hours postingestion. Arrange a follow-up for these patients in 24 hours.
Prognosis
- A 16% morbidity rate and a 1% mortality rate are associated with patients presenting with an acute overdose.
- The incidence of morbidity and mortality for a patient with chronic intoxication is 30% and 25%, respectively.
Patient Education
- Advise patients and their families that use or overuse of seemingly benign over-the-counter medications is sometimes dangerous. The ready availability of aspirin and aspirin-containing products does not establish the safety of aspirin.
- For excellent patient education resources, visit eMedicine's Drug Overdose Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Aspirin Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.
Miscellaneous
Medicolegal Pitfalls
- Failure to diagnose salicylate toxicity in a patient presenting with vague signs and symptoms, such as anxiety, tachypnea, agitation, delirium, tinnitus, or a combined respiratory alkalosis and metabolic acidosis
- Failure to initiate GI decontamination in a patient with acute salicylate ingestion who, subsequently, has recurrent toxicity from a salicylate bezoar
- Failure to hyperventilate a patient with severe salicylate poisoning who has just been intubated (when acid-base status had been maintained previously by the patient's own hyperventilation) to prevent lethal acidemia
- Failure to remove any possible ingestants from a patient's access when presentation follows an intentional ingestion, such as a suicide attempt
- Failure to diagnose and treat concomitant hypoglycemia in the salicylate-intoxicated patient; more common in children than in adults
- Failure to diagnose and treat hypoxemia caused by salicylate-induced pulmonary edema
- Failure to consider co-ingestions or other diagnoses
- Failure to consider recurrent or delayed toxicity from sustained-release preparations or from an unrecognized medication bezoar
More on Toxicity, Salicylate |
| Overview: Toxicity, Salicylate |
| Differential Diagnoses & Workup: Toxicity, Salicylate |
| Treatment & Medication: Toxicity, Salicylate |
 Follow-up: Toxicity, Salicylate |
| References |
| « Previous Page |
References
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Further Reading
Keywords
aspirin overdose, aspirin, aspirin poisoning, aspirin ingestion, salicylate toxicity, salicylate ingestion, salicylate overdose, salicylate poisoning
