Salicylate toxicity is the great toxicologic mimicker!!!

Step 1: When to Suspect Salicylate Overdose

* Signs of CNS stimulation* Tachypnea* Hyperthermia* Altered mental status* Signs of GI irritation* Nausea/Vomiting* Abdominal pain* Common “mimicker”* Sepsis* Acute abdomen

Step 2: Testing Plan

* Electrolyte panel* Anion gap metabolic acidosis* Sodium – Chloride – Bicarb* Normal anion gap (AG) is <10* Caused by salicylic acid and lactic acid* Blood gas* Mixed respiratory ALKALOSIS and metabolic ACIDOSIS

Step 3: Obtain Serum Salicylate Level

Step 4: Treatment Plan

* Mild salicylate toxicity* Alkalinize urine with sodium bicarbonate (NaHCO3) drip* Severe salicylate toxicity* Dialysis

Additional Reading

* Salicylate Poisoning (LITFL)