Sept 24, 2001: What is the treatment of the patient with salicylate toxicity?

As previously discussed, Ipecac administration and gastric lavage are not recommended in children.  Salicylates are absorbed by activated charcoal, so early administration of charcoal should be considered.  Furthermore, multiple-dose activated charcoal causes gastric dialysis, i.e., the drug is actually pulled from the blood into the GI tract to bind to the charcoal.

Alkalinization of the urine may be attempted.  Salicylates are renally excreted and ionized in an alkaline medium, so alkalinization of the urine will trap the salicylates in the urine.  However, it is extremely difficult to alkalinize the urine when the patient is excreting acids.  Urine pH must be greater than 7.5 to increase excretion.

Potassium and fluids must be repleted.  Patients can be extremely hypokalemic from the salicylate-induced passive efflux of potassium from the renal tubules.

Hemodialysis should be considered in a patient with an acute ingestion which clinical deterioration, a level greater than 100 mg/dL, acid-base abnormalities, and pulmonary or cerebral edema (as evidenced by an altered mental status).