For further information please discuss with toxicology (13 11 26).

Haemodialysis should be considered early in moderate to severe salicylate poisoning as urinary alkalisation can be difficult to achieve and may not be effective.Therefore potassium must be replaced via intravenous administration to maintain a mid-range concentration.

Urinary alkalinisation will also produce urinary potassium loss.

Urinary alkalinisation is not possible in the presence of hypokalaemia.

Discuss with toxicology (13 11 26) if unsure about indication. This is to be considered in cases with symptoms of Urinary alkalinisation requires a catheter, otherwise it is very difficult to monitor urinary pH in real time.

Phase 1: Respiratory stimulation - hyperventilation and respiratory alkalosis with alkaluriaħ.5).

Blood gases may indicate severity of poisoning.

CNS: Agitation, lethargy, seizures, coma.

CVS: Dehydration - careful assessment should be performed.

Resp : Hyperventilation - not always present in children, absence does not exclude significant toxicity.

Symptoms may be minimal initially with severe toxicity not evident until 6-12 hours.

Formulation -immediate release or sustained release.

Topical - Oil of Wintergreen (1 tsp 98% salicylate = 7000 mg), Dencorub, some teething gels.

Medications - Aspirin and aspirin containing drug compounds.

Salicylate is found in a number of oral and topical preparations including:

In moderate to severe salicylate poisoning, consider decontamination (activated charcoal) and the early enhancement of elimination (urinary alkalisation with or without haemodialysis).įor 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 BackgroundĪcute intoxication presents with classical symptoms of vomiting, tinnitus, hyperventilation, respiratory alkalosis and metabolic acidosis.

There is a poor correlation between salicylate concentration and toxicity and deterioration may still occur with falling serum concentrations due to rising CNS concentration.

The symptoms of acute salicylate poisoning may be minimal initially with severe toxicity not evident until 6-12 hours.

Poisoning – Acute guidelines for initial management Use of activated charcoal in poisonings Key points

Aspirin toxicity antidote