Salicylates Toxicity

Salicylates are agents found in hundreds of over-the-counter (OTC) medications and in numerous prescription drugs. These medications possess anti-inflammatory, analgesic, and antipyretic properties. They are available for ingestion as tablets, capsules, and liquids.
Therapeutic Uses of Salicylates
Therapeutic uses of salicylates are the following:

• Analgesic
• Anti-inflammatory
• Antipyretic
• Keratolytic
• Rubifacient

Acetylsalicylic acid is colorless or white in a crystalline, powder, or granular form. The chemical used in this drug is odorless and is soluble in water. Many people are using Aspirin as an anti-inflammatory agent to treat soft tissue and inflammation in the joints. Thrombosis is also prevented with a low dose of Aspirin.
Factors Influencing Salicylate Toxicity

• Dose
• Age of victim
• Renal function
• Dehydration
• Fever

Clinical Manifestations
PHASE 1
Phase 1 of the toxicity is characterized by hyperventilation resulting from direct respiratory center stimulation, leading to respiratory alkalosis and compensatory alkaluria. Both potassium and sodium bicarbonate are excreted in the urine. This phase may last as long as 12 hours.
PHASE 2
In phase 2, paradoxic aciduria in the presence of continued respiratory alkalosis occurs when sufficient potassium has been lost from the kidneys. This phase may begin within hours and may last 12-24 hours.
PHASE 3
Phase 3 includes dehydration, hypokalemia, and progressive metabolic acidosis. This phase may begin 4-6 hours after ingestion in a young infant or 24 hours or more after ingestion in an adolescent or adult.
Earliest Sign of Salicylate Toxicity

• Nausea and vomiting
• Tinnitus
• Diaphoresis or sweating

Other Early Sypmtoms

• Tachycardia
• Vertigo
• Hyperventilation
• Hyperactivity

Symptoms occurring as the toxicity or poisoning progresses:

• Agitation
• Delirium
• Disorientation
• Respiratory acidosis
• Hallucinations
• Stupor
• Coma
• Cardiovascular system collapse

Hyperthermia is an indication of severe toxicity, especially in young children.
Management:
Home Care

• Seek immediate medical help. Do NOT make a person throw up unless told to do so by poison control or a health care professional.
• Determine the following information: Patient’s age, weight, and condition, Name of the product (ingredients and strengths, if known), Time it was swallowed, Amount swallowed
• Call the Poison Control Center.
• Bring the patient to the nearest hospital.

Emergency Room Care

1. Treat respiratory depression
2. Induce gastric emptying: emesis or lavage.
3. Give activated charcoal to absorb aspirin. A cathartic may be given with charcoal to help assure intestinal cleansing.
4. Support patient with intravenous infusions as prescribed to establish hydration and correct electrolyte imbalances.
5. Enhance elimination of salicylates as directed by forced dieresis, alkalinization of urine, peritoneal dialysis or hemodialysis according to severity of intoxication.
6. Monitor serum salicylate level for efficacy of treatment.
7. Administer specific prescribed pharmacologic agent for bleeding and other problems.