Salicylate Overdose

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 11 June 2017

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

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Summary

Salicylate toxicity is the great toxicologic mimicker!!!

Step 1: When to Suspect Salicylate Overdose

* Signs of CNS stimulation* Tachypnea* Hyperthermia* Altered mental status* Signs of GI irritation* Nausea/Vomiting* Abdominal pain* Common “mimicker”* Sepsis* Acute abdomen

Step 2: Testing Plan

* Electrolyte panel* Anion gap metabolic acidosis* Sodium – Chloride – Bicarb* Normal anion gap (AG) is <10* Caused by salicylic acid and lactic acid* Blood gas* Mixed respiratory ALKALOSIS and metabolic ACIDOSIS

Step 3: Obtain Serum Salicylate Level

Step 4: Treatment Plan

* Mild salicylate toxicity* Alkalinize urine with sodium bicarbonate (NaHCO3) drip* Severe salicylate toxicity* Dialysis

Additional Reading

* Salicylate Poisoning (LITFL)

Transcript

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0:00.0	Hello, med students. My name is Zach Olson and thank you for downloading this week's
0:06.4	episode of the EM Clerkship Podcast. Last week, we discussed the approach to acetaminopin
0:17.5	overdose, the king of all toxic exposures, and acetyl cysteine.
0:21.5	That was the big takeaway.
0:22.6	That was the life-saving cure that you needed to remember.
0:27.8	This week we are discussing the queen of all tox overdoses.
0:33.7	Soliculate and aspirin overdose. Okay, we have a 22-year-old male possible aspirin overdose.
0:46.3	Found at home by the roommate who advised a history of depression.
0:50.3	He's on unknown meds for anxiety and depression.
0:53.3	Maybe he took half the bottle.
0:56.0	It was altered mental status when we found in response to pain and loud, verbal only.
1:02.0	BP 160 over 100.
1:05.0	Pulse of 120, respiration is 20 all the way here.
1:08.0	Gucosal 140.
1:09.0	We did find alcohol on scene as well.
1:11.6	Does anybody have any questions?
1:15.8	Okay, thank you.
1:20.6	This week, I want you to notice something.
1:23.3	With Tylenol, we were screening patients who were asymptomatic to see if they had sky-high
1:30.2	levels of acetaminophen in their blood before they moved into that symptomatic liver
1:35.4	death phase.
1:37.1	That was easy.
	...

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