Salicylate Toxicity

Salicylate poisoning can resemble anxiety, sepsis, or an isolated metabolic problem, but the patient may be deteriorating while still awake and talking. Salicylates stimulate ventilation and disrupt cellular energy production at the same time, producing a changing acid–base picture rather than one simple abnormality. Dehydration and hypokalemia then make renal elimination less effective. The immediate clinical priorities are to preserve the patient’s compensatory ventilation, recognize the mixed acid–base pattern, restore circulating volume and potassium, and use IV sodium bicarbonate to enhance salicylate excretion when poisoning is moderate or severe. Altered mental status, pulmonary edema, refractory acidosis, renal failure, or shock signals a need for emergent toxicology and dialysis evaluation.