Criteria

Salicylate poisoning diagnosis and management[1]

Salicylate poisonings are classed as mild, moderate, or severe based on clinical criteria in conjunction with salicylate levels. Threshold salicylate levels are different for adults and for children and older people. The levels below are generally applicable to acute poisoning; patients with chronic salicylism can be profoundly ill with much lower serum salicylate levels. Symptoms and signs of toxicity are more important than serum salicylate concentrations in determining need for therapy.

Acute Salicylate Poisoning

  • Mild poisoning: levels generally <60 mg/dL (<4.3 mmol/L) in adults, <45 mg/dL (<3.3 mmol/L) in children or older people; malaise, nausea, vomiting, tinnitus, and dizziness are usually seen.

  • Moderate poisoning: levels generally 60 to 80 mg/dL (4.3 to 5.8 mmol/L) in adults, 45 to 70 mg/dL (3.3 to 5.1 mmol/L) in children or older people; clinical features of moderate toxicity include those seen in mild toxicity plus tachypnea, hyperpyrexia, diaphoresis, volume depletion, loss of coordination, and restlessness.

  • Severe poisoning: levels generally >80 mg/dL (>5.8 mmol/L) in adults, >70 mg/dL (>5.1 mmol/L) in children or older people; clinical features may include hypotension, metabolic acidosis that persists after rehydration, oliguria, renal insufficiency or failure, and signs of neurologic toxicity, including hallucinations, stupor, seizures, or coma.

Chronic salicylate poisoning

  • Mild poisoning: tinnitus, tachypnea, and sweating. Serum levels generally <30 mg/dL (<2.2 mmol/L).

  • Severe poisoning: confusion and acute respiratory distress syndrome (ARDS). Serum levels generally >45 mg/dL (>3.3 mmol/L), though there is a great deal of variability.

Done nomogram[21]

The original Done nomogram predicts severity of poisoning in acute ingestions in children, based on serum level of salicylate measured 6 to 60 hours after exposure. Clinical criteria are included in the assessment. Subsequently, the Done nomogram has been found to be a weak predictor of clinical severity, with the highest predictive index of 0.79 in the mild salicylate level category.[22] The Done nomogram has not been shown to be superior to clinical assessment, and it should not be used to guide therapy.[13]

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