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ALL / Pharmacology
Salicylate overdose
Salicylate overdose
A key concept for the exam is to understand that salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis. In children metabolic acidosis tends to predominate.Features
- hyperventilation (centrally stimulates respiration)
- tinnitus
- lethargy
- sweating, pyrexia
- salicylates cause the uncoupling of oxidative phosphorylation leading to decreased adenosine triphosphate production, increased oxygen consumption and increased carbon dioxide and heat production
- nausea/vomiting
- hyperglycaemia and hypoglycaemia
- seizures
- coma
Treatment
- general (ABC, charcoal if < 1 hour since ingestion)
- urinary alkalinization with intravenous sodium bicarbonate
- enhances elimination of aspirin in the urine
- indications for haemodialysis in salicylate overdose
- serum concentration > 700mg/L
- metabolic acidosis resistant to treatment
- acute renal failure
- pulmonary oedema
- eizures
- coma
+PassMedicine Notes
A key concept for the exam is to understand that salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis. In children metabolic acidosis tends to predominate.
Features- hyperventilation (centrally stimulates respiration)
- tinnitus
- lethargy
- sweating, pyrexia
- salicylates cause the uncoupling of oxidative phosphorylation leading to decreased adenosine triphosphate production, increased oxygen consumption and increased carbon dioxide and heat production
- nausea/vomiting
- hyperglycaemia and hypoglycaemia
- seizures
- coma
- general (ABC, charcoal if < 1 hour since ingestion)
- urinary alkalinization with intravenous sodium bicarbonate
- enhances elimination of aspirin in the urine
- indications for haemodialysis in salicylate overdose
- serum concentration > 700mg/L
- metabolic acidosis resistant to treatment
- acute renal failure
- pulmonary oedema
- eizures
- coma