Salicylate Poisoning
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T39.0 DESCRIPTION Salicylate poisoning may result from oral and/or topical exposure. Salicylate products vary widely in concentration, e.g. oil of wintergreen is 100% methylsalicylate. As little as 4 mL of oil of wintergreen may be fatal in a child. DIAGNOSTIC CRITERIA Clinical Ingestion
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T39.0
DESCRIPTION
Salicylate poisoning may result from oral and/or topical exposure. Salicylate products vary widely in concentration, e.g. oil of wintergreen is 100% methylsalicylate. As little as 4 mL of oil of wintergreen may be fatal in a child.
DIAGNOSTIC CRITERIA
Clinical
- Ingestion of less than 150 mg/kg of aspirin will not cause toxicity except in a child with hepatic or renal disease.
- Ingestion of 150–300 mg/kg of aspirin may result in mild to moderate toxicity.
- Ingestion of > 300 mg/kg of aspirin may result in severe toxicity.
- Ingestion of > 500 mg/kg of aspirin should be considered a potentially lethal dose.
- Features include:
- fever,
- hyperventilation,
- nausea,
- renal failure,
- epigastric
- hypoglycaemia,
- pain
- vomiting,
- CNS depression,
- tinnitus
- respiratory alkalosis (initially) followed by metabolic acidosis.
- Monitor blood gases and electrolytes, urine output and urine pH.
- Monitor salicylate levels if possible (do not always correlate with clinical severity):
- Asymptomatic: peak plasma salicylate level of < 20 mg/dL (< 30 mg/dL in adolescents).
- Mild toxicity: Peak plasma salicylate level 20 to <45 mg/dL in child (30 to <60 mg/dL in adolescents).
- Moderate toxicity: Peak plasma salicylate 45 to 70 mg/dL in child (60 to 80 mg/dL in adolescents).
- Severe toxicity: Peak plasma salicylate level > 70 mg/dL in child (> 80 mg/dL in adolescents).
- Serial monitoring until declining levels are documented.
- Monitor and treat hypoglycaemia; patients with normoglycaemia may still be neuroglycopaenic.
GENERAL AND SUPPORTIVE MEASURES
- Consider gastric lavage, See: Poisoning, Treatment.
- Correct hydration.
MEDICINE TREATMENT
After gastric lavage:
- Activated charcoal.
- May be used for up to 12 hours due to delayed gastric emptying or if sustained-release/enteric-coated preparations were ingested.
Urinary alkalinisation
If metabolic acidosis (pH < 7.3) is present and/or salicylate levels are high, give:
- Sodium bicarbonate 8.4%, IV, 1 mL/kg bolus dose to increase pH to 7.4, administered over 1 hour (with maintenance fluid).
- Repeat bolus doses, if necessary, to maintain urine pH above 7.5.
- Monitor urine pH hourly and potassium levels 3 hourly.
For hydration:
- 5% dextrose saline, IV.
For bleeding:
- Vitamin K1, IV/oral, 1–5 mg/dose administered slowly 6 hourly.
Note:
Intravenous solution can be used orally.
REFERRAL
- Severe cases for ICU care: If arterial pH remains <7.2, refer for urinary alkalinisation and possible haemodialysis.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 18: Poisoning, 18.1 Poisoning, 18.1.13 Salicylate Poisoning