PA pure respiratory alkalosis may be noted due to tachypnea. Lab results may be normal or reveal slight electrolyte abnormalities at mild salicylate levels. Serial ABGs and salicylate levels should be obtained until levels clearly begin to downtrend and pH stabilizes. Consider a CT head if the patient has altered mental status. An ECG to evaluate for dysrhythmias should be obtained. Electrolytes, including calcium and magnesium, ABG, LFTs, CBC, lactate, and coagulation studies should be obtained. Acetaminophen levels should also be checked as confusion about what substance was ingested may occur. Serial levels are recommended as absorption is widely variable and will impact treatment. Pediatric patients will progress from mild symptoms to severe symptoms more quickly than adults.Ī salicylate level should be checked on all patients with a concern for salicylate toxicity. Patients suffering from chronic salicylate toxicity will experience similar symptoms as acute toxicity but at lower levels. Cardiac arrest may also occur with asystole being the most common rhythm. Hypotension due to acidosis and hypovolemia is possible. Endotracheal intubation, while not ideal for the metabolic disorders, may be necessary for airway protection. Hypoventilation may replace hyperventilation, which is concerning for impending respiratory failure. Patients may become obtunded and develop seizures. Damage to the basement membranes will cause cerebral and pulmonary edema. Salicylate levels greater than 100 mg/dL are considered severe toxicity and occur 12 to 24 hours after ingestion. Expect these symptoms 6 to 18 hours after ingestion. Tachypnea is more pronounced and is accompanied by tachycardia and orthostatic hypotension. These can include confusion, slurred speech, and hallucinations. Patients with moderate salicylate toxicity (80 to 100 mg/dL) will experience more severe neurological symptoms. However, this can occur at lower, non-toxic levels. The classic finding of tinnitus may also be present. For mild ingestions (salicylate levels 40 to 80 mg/dL) nausea, vomiting, and generalized abdominal pain are common. The severity of symptoms is dependent on the amount ingested. In an acute salicylate overdose, the onset of symptoms will occur within 3 to 8 hours. This information should be corroborated by family, friends, or EMS personnel. Finally, determine whether this was accidental or intentional. It is also critical to determine if there were any other substances ingested as this may complicate treatment and increase mortality. The later is important as it may affect the rate of absorption. These include time of ingestion, amount ingested, as well as formulation. If the patient can provide history, there are several important pieces of information to obtain. Theoretically, this may occur in children or patients with compromised skin, such as due to burns or psoriasis. However, the serum concentrations do not reach toxic levels. Elimination is further delayed in patients with underlying renal and liver disease.ĭermal salicylate preparations have been shown to reach the bloodstream. With increased salicylate levels, these pathways become saturated resulting in zero order elimination. The liver metabolizes salicylates by first-order elimination, and the inactive metabolites are then excreted in the urine. Absorption continues in the small intestine. Aspirin can cause pyloric sphincter spasms, which increases the amount of time in the stomach allowing for more absorption. Aspirin has the propensity to form bezoars which will delay absorption. Food in the stomach at the time of ingestion can delay absorption. The formulation of the salicylate (extended vs. A variety of factors can affect absorption. The ionization constant of aspirin is 3, which makes it is more readily absorbed in acidic environments such as the stomach.
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