Salicylate poisoning

Patients who do not meet criteria for hospital referral and are observed at home should be followed up about 24 hours after ingestion.

Patients with signs and symptoms suggestive of mild toxicity (malaise, nausea, vomiting, and dizziness) should be monitored closely, paying particular attention to any changes in clinical picture, urinary output, and fluid status. Salicylate levels in this group should be measured every 2 to 4 hours until the concentration peaks (can occur up to 24 hours after ingestion).[18]Dargan PI, Wallace CI, Jones AL. An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. 2002 May;19(3):206-9. https://emj.bmj.com/content/19/3/206.full http://www.ncbi.nlm.nih.gov/pubmed/11971828?tool=bestpractice.com

Serum electrolytes and either ABG or venous blood gas should be measured frequently if alkalinization is induced and/or the patient requires intubation and mechanical ventilation.[13]American College of Medical Toxicology. Guidance document: management priorities in salicylate toxicity. J Med Toxicol. 2015 Mar;11(1):149-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371029 ​ In addition, a serum electrolyte panel should be repeated frequently to monitor for electrolyte abnormalities. 

If deliberate self-harm or suicidal intent is a concern, the patient should be referred for psychiatric evaluation when stable. Once symptoms of toxicity have resolved and the patient is discharged from the hospital, no further medical follow-up is required.