Salicylate poisoning

National Poisons Information Service/TOXBASE^Ⓡ

In the UK, salicylate poisonings are classed as mild, moderate, or severe based on clinical criteria in conjunction with plasma salicylate levels.[2]National Poisons Information Service. TOXBASE®: salicylic acids and salicylates (salicylates). May 2019 [internet publication]. https://www.toxbase.org/Poisons-Index-A-Z/S-Products/Salicylates The levels below are generally applicable to acute poisoning; patients with chronic salicylism can be profoundly unwell with much lower plasma salicylate levels. Be aware that patients with chronic salicylate intoxication may present with only non-specific features such as confusion, malaise, and dyspnoea.[2]National Poisons Information Service. TOXBASE®: salicylic acids and salicylates (salicylates). May 2019 [internet publication]. https://www.toxbase.org/Poisons-Index-A-Z/S-Products/Salicylates

• Mild poisoning

  • Usually associated with a peak salicylate concentration of <300 mg/L (<2.2 mmol/L): nausea, vomiting, tinnitus, deafness, lethargy, or dizziness.

• Moderate poisoning

  • Usually associated with a salicylate concentration of 300 to 700 mg/L (2.2 to 5.1 mmol/L): dehydration, restlessness, sweating, warm extremities with bounding pulses, increased respiratory rate, and hyperventilation. Respiratory alkalosis is often present at lower concentrations; metabolic acidosis may co-exist.

• Severe poisoning

  • Usually associated with a peak salicylate concentration of >700 mg/L (>5.1 mmol/L): cardiac dysrhythmias, acute non-cardiogenic pulmonary oedema, cerebral oedema, convulsions, confusion, coma, hyperpyrexia, heart failure, acute kidney injury, and worsening metabolic and lactic acidosis.

  • Central nervous system features including confusion, disorientation, coma, and convulsions are more common in children.