Complications

Complication
Timeframe
Likelihood
short term
high

Incidence depends on amount and duration of ingestion.[1]

Intubate and ventilate the patient mechanically.

Usual tidal volume required to avoid high peak airway pressures should be in the range of 4 to 6 mL/kg ideal body weight.

Arrange urgent haemodialysis for patients with non-cardiogenic pulmonary oedema in the setting of salicylate poisoning.

Acute respiratory distress syndrome (ARDS)

short term
high

High probability in patients with prolonged corrected QT interval, particularly when combined with bradycardia or extremes of pH.

Treat cardiac arrest according to advanced cardiac life support guidelines, including CPR, adrenaline administration, and defibrillation in the presence of a shockable rhythm.

Although not evidence-based, administration of sodium bicarbonate is recommended for salicylate-induced cardiac arrest.

Cardiac arrest

short term
high

High probability of seizures in patients with salicylate levels of ≥75 mg/L (≥5.4 mmol/L).[1]

Although anticonvulsants are not usually needed, terminate prolonged seizures with benzodiazepines if necessary. However, because failure to hyperventilate may be life-threatening, these patients frequently require intubation, mechanical hyperventilation, and haemodialysis.

Generalised seizures in adults

short term
low

May affect a few patients. Usually resolves with resolution of toxicity.

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