Salicylate overdose

• Give 4 examples of salicylates

  Aspirin

  Magnesium salicylate

  Diflunisal

  Bismuth subsalicylate
• Do salicylates work best as anitplatelets at high or low doses?

  Low
• Do salicylates work best as analgesics at high or low doses?

  High
• What clinical manifestations would you expect in mild salicylate toxicity?

  Gastric lining irritation

  Ototoxicity
• What clinical manifestation would you expect in moderate/severe salicylate toxicity?

  Stimulation of the cerebral medulla leading to hyperventilation and respiratory alkalosis.
• Give 6 clinical findings in salicylate overdose

  Warm peripheries

  Bounding pulse

  Tachypnoea

  Hyperventilation

  Cardiac arrhythmia

  Acute pulmonary oedema
• Symptoms in mild salicylate overdose?

  Nausea and vomiting

  Epigastric pain

  Tinnitus

  Dizziness

  Lethargy
• Symptoms in moderate salicylate overdose?

  Sweating

  Fever

  Dyspnoea
• Symptoms in severe salicylate overdose?

  Confusion

  Convulsions

  Coma
• What blood test is important in salicylate overdose patients?

  Plasma salicylate concentration
• When should you take blood tests for plasma salicylate concentration?

  2 hours post-ingestion, then every two hours until you reach peak concentration.
• Salicylate overdose is categorised into mild, moderate and severe. At what salicylate concentration levels is each category?

  Mild - <300mg/L

  Moderate - 300-700mg/L

  Severe - >700mg/L
• How do you manage salicylate overdose?

  No antidote so conservative management. Can give activated charcoal if presenting within one hour of ingestion, IV fluid resuscitation, potassium replacement, sodium bicarbonate, cooling measures, CPAP, haemodialysis and IV benzodiazepines in convulsions.
• Why do you give sodium bicarbonate in salicylate overdose?

  It reduces the transfer of salicylates to the central nervous system and enhances urinary secretion.
• What are 4 complications of salicylate overdose?

  Acute respiratory distress syndrome

  Seizures

  Drug induced hepatitis

  Cardiac arrest
• Why is cardiac arrest a complication of salicylate overdose?

  Can lead to prolonged QT interval which leads to ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation, putting the patient at risk of cardiac arrest.
• What is acute respiratory distress sydrome?

  Bilateral pulmonary oedema and hypoxia.