Medication Summary
No specific antidote for salicylate poisoning is available. Therapy is focused on immediate resuscitation, correction of volume depletion and metabolic derangement, GI tract decontamination, and reduction of the body's salicylate burden. Early consultation with a medical toxicologist is prudent.
As previously mentioned, initial treatment should include the use of oral activated charcoal, especially if the patient presents within 1 hour of ingestion.
In a study, whole bowel irrigation (WBI) with polyethylene glycol was found to be more effective than single-dose activated charcoal in reducing absorption of enteric-coated acetylsalicylic acid. [28] When enteric-coated aspirin has been ingested or when salicylate levels do not decrease despite treatment with charcoal, WBI should probably be used in addition to charcoal therapy.
Antidotes, Other
Class Summary
Consider activated charcoal decontamination in any patient who presents within 4 hours of ingestion. Activated charcoal is used for drug absorption and may be all that is required in mild to moderate toxicity. Activated charcoal is not absorbed and is excreted entirely through the GI tract.
Activated charcoal (Actidose-Aqua, Char-Caps, Kerr Insta-Char)
Activated charcoal can limit further gut absorption by binding to available salicylate. This is effective for the regular and sustained-release preparation. No convincing data support the use of repeated doses of activated charcoal in salicylate toxicity. Some authorities recommend repeated doses of activated charcoal to enhance elimination.
Laxatives, Osmotic
Class Summary
Laxatives with strong osmotic effects that cause cathartic actions to empty the bowel may be useful in this setting.
Polyethylene glycol (Miralax, Dulcolax Balance)
Polyethylene glycol is a laxative with strong electrolyte and osmotic effects that has cathartic actions in the GI tract. Consider WBI when sustained-release products are involved. Remember that this agent does not adsorb anything but instead merely pushes things through the GI tract at a faster rate.
Urinary Alkalinizing Agents
Class Summary
Sodium bicarbonate is used as a gastric, systemic, and urinary alkalinizer and has been administered in the treatment of acidosis resulting from metabolic and respiratory causes. It also increases renal clearance of acidic drugs. Alkalization of the urine enhances elimination of salicylates through ion trapping in the renal tubules.
Sodium bicarbonate
Constant infusion of sodium bicarbonate produces urinary alkalization if the serum potassium is adequate (typically, >4.5 mEq/L). Urinary alkalization promotes the excretion of salicylate.
If the serum potassium level is low or in the lower end of the reference range (eg, < 4.5 mEq/L), hydrogen ions, instead of potassium ions, follow bicarbonate ions into the urine. Hence, the urine may remain acidic during bicarbonate infusion without potassium repletion.
