Endotracheal intubation, while not ideal for the metabolic disorders, may be necessary for airway protection. Hypoventilation may replace hyperventilation, which is concerning for impending respiratory failure. Patients may become obtunded and develop seizures. Damage to the basement membranes will cause cerebral and pulmonary edema. Salicylate levels greater than 100 mg/dL are considered severe toxicity and occur 12 to 24 hours after ingestion. Expect these symptoms 6 to 18 hours after ingestion. Tachypnea is more pronounced and is accompanied by tachycardia and orthostatic hypotension. These can include confusion, slurred speech, and hallucinations.
Patients with moderate salicylate toxicity (80 to 100 mg/dL) will experience more severe neurological symptoms. However, this can occur at lower, non-toxic levels. The classic finding of tinnitus may also be present.
For mild ingestions (salicylate levels 40 to 80 mg/dL) nausea, vomiting, and generalized abdominal pain are common. The severity of symptoms is dependent on the amount ingested. In an acute salicylate overdose, the onset of symptoms will occur within 3 to 8 hours. This information should be corroborated by family, friends, or EMS personnel. Finally, determine whether this was accidental or intentional. It is also critical to determine if there were any other substances ingested as this may complicate treatment and increase mortality. The later is important as it may affect the rate of absorption. These include time of ingestion, amount ingested, as well as formulation. If the patient can provide history, there are several important pieces of information to obtain. Theoretically, this may occur in children or patients with compromised skin, such as due to burns or psoriasis. However, the serum concentrations do not reach toxic levels. Elimination is further delayed in patients with underlying renal and liver disease.ĭermal salicylate preparations have been shown to reach the bloodstream. With increased salicylate levels, these pathways become saturated resulting in zero order elimination. The liver metabolizes salicylates by first-order elimination, and the inactive metabolites are then excreted in the urine. Absorption continues in the small intestine. Aspirin can cause pyloric sphincter spasms, which increases the amount of time in the stomach allowing for more absorption. Aspirin has the propensity to form bezoars which will delay absorption. Food in the stomach at the time of ingestion can delay absorption. The formulation of the salicylate (extended vs. A variety of factors can affect absorption. The ionization constant of aspirin is 3, which makes it is more readily absorbed in acidic environments such as the stomach.
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