Highlights & Basics
- Salicylate poisoning is potentially fatal. It can present acutely or indolently with more chronic exposure.
- Diagnosis should be considered in any patient presenting with a history of unknown toxin ingestion or exposure, particularly in the presence of an unexplained acid-base disturbance. Early consultation with the local poison control center and/or toxicologist is recommended.
- Clinical presentation is more important than salicylate levels in directing therapeutic decisions.
- Alkalinization of serum and urine is considered first-line treatment for patients with moderate or severe clinical signs and symptoms. Key to successful alkalinization is aggressive management of hypokalemia.
- Emergency hemodialysis is recommended for unstable patients with renal insufficiency, acute respiratory failure, metabolic acidosis refractory to alkalinization, prolonged corrected QT interval, noncardiogenic pulmonary edema, altered mental status, seizures, or salicylate levels >100 mg/dL.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Palmer BF, Clegg DJ. Salicylate toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-55.[Abstract]
Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131.[Abstract][Full Text]
American College of Medical Toxicology. Guidance document: management priorities in salicylate toxicity. J Med Toxicol. 2015 Mar;11(1):149-52.[Full Text]
Dargan PI, Wallace CI, Jones AL. An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. 2002 May;19(3):206-9. [Abstract][Full Text]
1. Palmer BF, Clegg DJ. Salicylate toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-55.[Abstract]
2. Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131.[Abstract][Full Text]
3. Gummin DD, Mowry JB, Beuhler MC, et al. 2021 Annual report of the National Poison Data System(©) (NPDS) from America's Poison Centers: 39th annual report. Clin Toxicol (Phila). 2022 Dec;60(12):1381-643.[Abstract][Full Text]
4. Srisuma S, Cao D, Kleinschmidt K, et al. Missed opportunities?: an evaluation of potentially preventable poisoning deaths. Clin Toxicol (Phila). 2016 Mar 21;54(5):441-6.[Abstract]
5. Hawton K, Simkin S, Deeks J, et al. UK legislation on analgesic packs: before and after study of long term effect on poisonings. BMJ. 2004 Nov 6;329(7474):1076.[Abstract][Full Text]
6. Johnson PN, Welch DW. Methyl salicylate/aspirin (salicylate) equivalence: who do you trust? Vet Hum Toxicol. 1984 Aug;26(4):317-8.
7. Gabow PA, Anderson RJ, Potts DE, et al. Acid-base disturbances in the salicylate-intoxicated adult. Arch Intern Med. 1978 Oct;138(10):1481-4.[Abstract]
8. Reed JR, Palmisano PA. Central nervous system salicylate. Clin Toxicol. 1975;8(6):623-31.[Abstract]
9. Jacob J, Lavonas EJ. Falsely normal anion gap in severe salicylate poisoning caused by laboratory interference. Ann Emerg Med. 2011 Sep;58(3):280-1[Abstract]
10. Rich RR, Johnson JS. Salicylate hepatotoxicity in patients with juvenile rheumatoid arthritis. Arthritis Rheum. 1973 Jan-Feb;16(1):1-9.[Abstract]
11. Wolfe JD, Metzger AL, Goldstein RC. Aspirin hepatitis. Ann Intern Med. 1974 Jan;80(1):74-6.[Abstract]
12. Matthay MA, Arabi Y, Arroliga AC, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2024 Jan 1;209(1):37-47.[Abstract][Full Text]
13. American College of Medical Toxicology. Guidance document: management priorities in salicylate toxicity. J Med Toxicol. 2015 Mar;11(1):149-52.[Full Text]
14. Kent K, Ganetsky M, Cohen J, et al. Non-fatal ventricular dysrhythmias associated with severe salicylate toxicity. Clin Toxicol (Phila). 2008 Apr;46(4):297-9.[Abstract]
15. Meaden CW, Calello DP. Bismuth subsalicylate poisoning. N Engl J Med. 2022 Dec 1;387(22):2074.
16. Sainsbury SJ. Fatal salicylate toxicity from bismuth subsalicylate. West J Med. 1991 Dec;155(6):637-9.[Full Text]
17. Halani S, Wu PE. Salicylate toxicity from chronic bismuth subsalicylate use. BMJ Case Rep. 2020 Nov 30;13(11):e236929.[Abstract][Full Text]
18. Dargan PI, Wallace CI, Jones AL. An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. 2002 May;19(3):206-9. [Abstract][Full Text]
19. Fahlen M, Duarte AG. Gait disturbance, confusion, and coma in a 93-year-old blind woman. Chest. 2001 Jul;120(1):295-7.[Abstract][Full Text]
20. Lynd LD, Richardson KJ, Purssell RA, et al. An evaluation of the osmole gap as a screening test for toxic alcohol poisoning. BMC Emerg Med. 2008 Apr 28;8:5.[Abstract][Full Text]
21. Done AK. Aspirin overdose: incidence, diagnosis and management. Pediatrics. 1978 Nov;62(5 Pt 2 Suppl):890-7.
22. Dugandzic RM, Tierney MG, Dickinson GE, et al. Evaluation of the validity of the Done nomogram in the management of acute salicylate intoxication. Ann Emerg Med. 1989 Nov;18(11):1186-90.[Abstract]
23. The Royal Children's Hospital Melbourne. Salicylates poisoning. June 2017 [internet publication].[Full Text]
24. Mégarbane B, Oberlin M, Alvarez JC, et al. Management of pharmaceutical and recreational drug poisoning. Ann Intensive Care. 2020 Nov 23;10(1):157.[Abstract][Full Text]
25. Barone, J, Raia J, Huang YC. Evaluation of the effects of multiple-dose activated charcoal on the absorption of orally administered salicylate in a simulated toxic ingestion model. Ann Emerg Med. 1988 Jan;17(1):34-7.[Abstract]
26. Neuvonen PJ, Elfving SM, Elonen E. Reduction of absorption of digoxin, phenytoin, and aspirin by activated charcoal in man. Eur J Clin Pharmacol. 1978 May 31;13(3):213-8.[Abstract]
27. Oh MS, Halperin ML. Toxin-induced metabolic acidosis. In: Gennari FJ, Adrogue HJ, Galla JH, et al, eds. Acid-base disorders and their treatment. Boca Raton, FL: Taylor & Francis; 2005:383-416.
28. Curry SC, Pizon AF, Riley BD, et al. Effect of intravenous albumin infusion on brain salicylate concentration. Acad Emerg Med. 2007 Jun;14(6):508-14.[Abstract][Full Text]
29. Davison C. Salicylate metabolism in man. Ann NY Acad Sci. 1971 Jul 6;179:249-68.[Abstract]
30. American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.[Abstract][Full Text]
31. Proudfoot AT, Krenzelok EP, Vale JA. Position paper on urine alkalinization. J Toxicol Clin Toxicol. 2004;42(1):1-26.[Abstract][Full Text]
32. Shively RM, Hoffman RS, Manini AF. Acute salicylate poisoning: risk factors for severe outcome. Clin Toxicol (Phila). 2017 Mar;55(3):175-80.[Abstract][Full Text]
33. Done AK. Salicylate intoxication: significance of measurements of salicylate in blood in cases of acute ingestion. Pediatrics. 1960 Nov;26:800-7.[Abstract]
