All right, so welcome back to the internet book of critical care podcast. I'm here with Adam

Thomas and we're going to talk about solacilism. Guys, this is a big one. I love this overdose. Not good

for the patients, but it's a lot of fun because there's some crazy nuances when it comes to

acid-based disturbances here. And in particular,

it's one of those hardcore overdoses that if you miss it or don't manage it well, things can go bad

very quickly. So today we'll talk about the approach to diagnosis. The bulk of the podcast is going to be

around treatment. So specifics around airway management, neuroglycopenia, alkalization of the serum in the urine,

what to do about volume resuscitation, how to enhance elimination through hemodialysis,

and then some nuances around lab monitoring and when to stop. Josh, let's get it started.

Let's go into that diagnosis. Who do we expect to see this overdose in? There are roughly two

phenotypes of solosilat intoxication.

One type is a suicide attempt.

I mean, that's not uncommon because lots of folks have aspirin in their medicine counters.

And the lethal dose here is extremely low.

So just 30 tablets of 325 milligrams aspirin can be a lethal dose.

So if someone has a whole bottle of extra strength aspirin, that can be multiple times lethal

dose, which is kind of terrifying. So number one, suicide. And number two would be inadvertent

overdose in folks who may be a little bit confused, maybe borderline dementia and they're

popping aspirin whenever they have a pain or whenever they feel like it. And over time,

they accumulate this total body overload of aspirin. And then there's some rare applications that

we'll see it. So the classic one that we have under the radar is that peptobismol. That's

Bismuth subsilicidate. So people are crushing the peptobismal for their diarrhea and they might be

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