Salicylate poisoning - wikipedia Salicylate poisoning Salicylate poisoning Synonyms Salicylism, salicylate toxicity, aspirin poisoning, aspirin toxicity, aspirin overdose A skeletal structural formula for aspirin. Specialty Emergency medicine Symptoms Ringing in the ears, nausea, abdominal pain, fast breathing rate Complications Swelling of the brain or lungs, seizures, low blood sugar, cardiac arrest Diagnostic method Early : Slightly elevated blood aspirin levels ~ 2.2 mmol / L ( 30 mg / dL, 300 mg / L ), respiratory alkalosis Late : Metabolic acidosis Differential diagnosis Sepsis, heart attack, agitation Prevention Child - resistant packaging, low number of pills per package Treatment Activated charcoal, intravenous sodium bicarbonate with dextrose and potassium chloride, dialysis Prognosis ~ 1 % risk of death Frequency > 20,000 per year ( US ) Salicylate poisoning, also known as aspirin poisoning, is the acute or chronic poisoning with a salicylate such as aspirin. The classic symptoms are ringing in the ears, nausea, abdominal pain, and a fast breathing rate. Early on these may be subtle while larger doses may result in fever. Complications can include swelling of the brain or lungs, seizures, low blood sugar, or cardiac arrest. While usually due to aspirin, other possible causes include oil of wintergreen and bismuth subsalicylate. Excess doses can be either on purpose or accidental. Small amounts of oil of wintergreen can be toxic. Diagnosis is generally based on repeated blood tests measuring aspirin levels and blood gases. While a type of graph has been created to try to assist with diagnosis, its general use is not recommended. In overdose maximum blood levels may not occur for more than 12 hours. Efforts to prevent poisoning include child - resistant packaging and a lower number of pills per package. Treatment may include activated charcoal, intravenous sodium bicarbonate with dextrose and potassium chloride, and dialysis. Giving dextrose may be useful even if the blood sugar is normal. Dialysis is recommended in those with kidney failure, decreased level of consciousness, blood pH less than 7.2, or high blood salicylate levels. If a person requires intubation a fast respiratory rate may be required. The toxic effects of salicylates have been described since at least 1877. In 2004 more than 20,000 cases with 43 deaths were reported in the United States. About 1 % of those with an acute overdose die while chronic overdoses may have worse outcomes. Older people are at higher risks of toxicity for any given dose. Contents 1 Signs and symptoms 1.1 Severity 2 Pathophysiology 3 Diagnosis 4 Prevention 5 Treatment 5.1 Intravenous fluids 5.2 Dialysis 6 Epidemiology 7 History 8 See also 9 References 10 External links Signs and symptoms Main symptoms of aspirin overdose. Aspirin overdose has potentially serious consequences, sometimes leading to significant morbidity and death. Patients with mild intoxication frequently have nausea and vomiting, abdominal pain, lethargy, ringing in the ears, and dizziness. More significant signs and symptoms occur in more severe poisonings and include high body temperature, fast breathing rate, respiratory alkalosis, metabolic acidosis, low blood potassium, low blood glucose, hallucinations, confusion, seizure, cerebral edema, and coma. The most common cause of death following an aspirin overdose is cardiopulmonary arrest usually due to pulmonary edema. Severity Severity Mild ( 150 mg / kg ) Moderate ( 150 -- 300 mg / kg ) Severe ( 300 -- 500 mg / kg ) Toxicity No toxicity expected Mild to moderate toxicity expected Life - threatening toxicity expected Symptoms Nausea, vomiting, dizziness Nausea, vomiting, ringing in the ears, headache, confusion, hyperventilation, tachycardia, fever Delirium, hallucinations, seizures, coma, respiratory arrest Pathophysiology Acute aspirin or salicylates overdose or poisoning can cause initial respiratory alkalosis though metabolic acidosis ensues thereafter. The acid - base, fluid, and electrolyte abnormalities observed in salicylate toxicity can be grouped into three broad phases : Phase I : Characterized by hyperventilation resulting from direct respiratory center stimulation, leading to respiratory alkalosis and compensatory alkaluria. Potassium and sodium bicarbonate are excreted in the urine. This phase may last as long as 12 hours. Phase II : Characterized by paradoxic aciduria in the presence of continued respiratory alkalosis occurs when sufficient potassium has been lost from the kidneys. This phase may begin within hours and may last 12 -- 24 hours. Phase III : Characterized by dehydration, hypokalemia, and progressive metabolic acidosis. This phase may begin 4 -- 6 hours after ingestion in a young infant or 24 hours or more after ingestion in an adolescent or adult. Diagnosis The acutely toxic dose of aspirin is generally considered greater than 150 mg per kg of body mass. Moderate toxicity occurs at doses up to 300 mg / kg, severe toxicity occurs between 300 and 500 mg / kg, and a potentially lethal dose is greater than 500 mg / kg. Chronic toxicity may occur following doses of 100 mg / kg per day for two or more days. Monitoring of biochemical parameters such as electrolytes and solutes, liver and kidney function, urinalysis, and complete blood count is undertaken along with frequent checking of salicylate and blood sugar levels. Arterial blood gas assessments will typically find respiratory alkalosis early in the course of the overdose due to hyperstimulation of the respiratory center, and may be the only finding in a mild overdose. An anion - gap metabolic acidosis occurs later in the course of the overdose especially if it is a moderate to severe overdose, due to the increase in protons ( acidic contents ) in the blood. The diagnosis of poisoning usually involves measurement of plasma salicylate, the active metabolite of aspirin, by automated spectrophotometric methods. Plasma salicylate levels generally range from 30 -- 100 mg / L ( 3 -- 10 mg / dL ) after usual therapeutic doses, 50 -- 300 mg / L in patients taking high doses and 700 -- 1400 mg / L following acute overdose. Patients may undergo repeated testing until their peak plasma salicylate level can be estimated. Optimally, plasma levels should be assessed four hours after ingestion and then every two hours after that to allow calculation of the maximum level, which can then be used as a guide to the degree of toxicity expected. Patients may also be treated according to their individual symptoms. Prevention A bottle of aspirin with a child - resistant cap bearing the instruction `` push down and turn to open '' Efforts to prevent poisoning include child - resistant packaging and a lower number of pills per package. Treatment Initial treatment of an acute overdose involves resuscitation followed by gastric decontamination by administering activated charcoal, which adsorbs the aspirin in the gastrointestinal tract. Stomach pumping is no longer routinely used in the treatment of poisonings but is sometimes considered if the patient has ingested a potentially lethal amount less than one hour before presentation. Inducing vomiting with syrup of ipecac is not recommended. Repeated doses of charcoal have been proposed to be beneficial in cases of aspirin overdosing, although one study found that they might not be of significant value. Regardless, most clinical toxicologists will administer additional charcoal if serum salicylate levels are increasing. Intravenous fluids Intravenous fluids containing dextrose such as D5W are recommended to keep a urinary output between 2 and 3 ml / kg / h. Sodium bicarbonate is given in a significant aspirin overdose ( salicylate level greater than 35 mg / dl 6 hours after ingestion ) regardless of the serum pH, as it enhances elimination of aspirin in the urine. It is given until a urine pH between 7.5 and 8.0 is achieved. Dialysis Hemodialysis can be used to enhance the removal of salicylate from the blood. Hemodialysis is usually used in those who are severely poisoned. Example of severe poisoning include people with high salicylate blood levels : 7.25 mmol / L ( 100 mg / dL ) in acute ingestions or 40 mg / dL in chronic ingestions, significant neurotoxicity ( agitation, coma, convulsions ), kidney failure, pulmonary edema, or cardiovascular instability. Hemodialysis also has the advantage of restoring electrolyte and acid - base abnormalities while removing salicylate. Epidemiology During the latter part of the 20th century, the number of poisonings from salicylates declined, mainly because of the increased popularity of other over-the - counter analgesics such as paracetamol ( acetaminophen ). Fifty - two deaths involving single - ingredient aspirin were reported in the United States in 2000 ; however, in all but three of these cases, the reason for the ingestion of lethal doses was intentional -- predominantly suicidal. History Aspirin poisoning has controversially been cited as a possible cause of the high mortality rate during the 1918 flu pandemic, which killed 50 to 100 million people. See also NSAID hypersensitivity reactions Reye syndrome Salicylate sensitivity References ^ Jump up to : O'Malley, GF ( May 2007 ). `` Emergency department management of the salicylate - poisoned patient ''. Emergency medicine clinics of North America. 25 ( 2 ) : 333 -- 46 ; abstract viii. doi : 10.1016 / j. emc. 2007.02. 012. PMID 17482023. ^ Jump up to : Walls, Ron ( 2017 ). Rosens Emergency Medicine Concepts and Clinical Practice ( 9th ed. ). Elsevier. p. X. ISBN 978 - 0323354790. ^ Jump up to : McNeil Consumer & Specialty Pharmaceuticals ( 2002 ). `` Assessment of Safety of aspirin and other Nonsteroidal Anti-Inflammatory Drugs ( NSAIDs ) ''. FDA. Archived from the original on 14 May 2017. Retrieved 27 June 2017. Jump up ^ Brenner, George M. ; Stevens, Craig ( 2012 ). Pharmacology E-Book : with STUDENT CONSULT Online Access ( 4 ed. ). Elsevier Health Sciences. p. 319. ISBN 1455702781. Archived from the original on 2017 - 08 - 18. ^ Jump up to : Roland, Peter S. ; Rutka, John A. ( 2004 ). Ototoxicity. PMPH - USA. p. 28. ISBN 9781550092639. Archived from the original on 10 September 2017. Retrieved 27 June 2017. Jump up ^ MedlinePlus > Aspirin Archived 2009 - 07 - 20 at the Wayback Machine. Last Reviewed - 02 / 01 / 2009. Jump up ^ Thisted, B ; Krantz, T ; Strøom, J ; Sørensen, MB ( May 1987 ). `` Acute salicylate self - poisoning in 177 consecutive patients treated in ICU ''. Acta anaesthesiologica Scandinavica. 31 ( 4 ) : 312 -- 6. doi : 10.1111 / j. 1399 - 6576.1987. tb02574. x. ISSN 0001 - 5172. PMID 3591255. ^ Jump up to : Salicylate Toxicity at eMedicine Jump up ^ `` Drugs and Lactation Database ( LactMed ) ''. toxnet.nlm.nih.gov. Archived from the original on 2017 - 09 - 10. This article incorporates text from this source, which is in the public domain. ^ Jump up to : Chyka PA, Erdman AR, Christianson G, Wax PM, Booze LL, Manoguerra AS, Caravati EM, Nelson LS, Olson KR, Cobaugh DJ, Scharman EJ, Woolf AD, Troutman WG ( 2007 ). `` Salicylate poisoning : an evidence - based consensus guideline for out - of - hospital management ''. Clinical Toxicology. 45 ( 2 ) : 95 -- 131. doi : 10.1080 / 15563650600907140. PMID 17364628. ^ Jump up to : Temple, AR ( February 1981 ). `` Acute and chronic effects of aspirin toxicity and their treatment ''. Archives of Internal Medicine. 141 ( 3 Spec No ) : 364 -- 9. doi : 10.1001 / archinte. 141.3. 364. ISSN 0003 - 9926. PMID 7469627. Jump up ^ R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 9th edition, Biomedical Publications, Seal Beach, CA, 2011, pp. 20 - 23. ^ Jump up to : Dargan, PI ; Wallace, CI ; Jones, AL ( May 2002 ). `` An evidenced based flowchart to guide the management of acute salicylate ( aspirin ) overdose ''. Emergency medicine journal : EMJ. 19 ( 3 ) : 206 -- 9. doi : 10.1136 / emj. 19.3. 206. ISSN 1472 - 0205. PMC 1725844. PMID 11971828. Jump up ^ Meredith TJ, Vale JA ( 1986 ). `` Non-narcotic analgesics. Problems of overdosage ''. Drugs. 32 ( Suppl 4 ) : 117 -- 205. doi : 10.2165 / 00003495 - 198600324 - 00013. ISSN 0012 - 6667. PMID 3552583. Jump up ^ Vale JA, Kulig K ( 2004 ). `` Position paper : gastric lavage ''. Journal of Toxicology : Clinical Toxicology. 42 ( 7 ) : 933 -- 43. doi : 10.1081 / CLT - 200045006. PMID 15641639. Jump up ^ Hillman, RJ ; Prescott, LF ( Nov 1985 ). `` Treatment of salicylate poisoning with repeated oral charcoal ''. British Medical Journal ( Clinical research ed. ). 291 ( 6507 ) : 1472. doi : 10.1136 / bmj. 291.6507. 1472. ISSN 0267 - 0623. PMC 1418067. PMID 3933714. Jump up ^ Kirshenbaum LA, Mathews SC, Sitar DS, Tenenbein M ( Jun 1990 ). `` Does multiple - dose charcoal therapy enhance salicylate excretion ? ''. Archives of Internal Medicine. 150 ( 6 ) : 1281 -- 3. doi : 10.1001 / archinte. 150.6. 1281. ISSN 0003 - 9926. PMID 2191636. Jump up ^ Marx, John ( 2006 ). Rosen 's emergency medicine : concepts and clinical practice. Mosby / Elsevier. p. 2341. ISBN 978 - 0 - 323 - 02845 - 5. ^ Jump up to : Marx, John ( 2006 ). Rosen 's emergency medicine : concepts and clinical practice. Mosby / Elsevier. p. 2342. ISBN 978 - 0 - 323 - 02845 - 5. Jump up ^ Gaudreault, P ; Temple, AR ; Lovejoy Fh, FH ( October 1982 ). `` The relative severity of acute versus chronic salicylate poisoning in children : a clinical comparison ''. Pediatrics. 70 ( 4 ) : 566 -- 9. ISSN 0031 - 4005. PMID 7122154. Jump up ^ Litovitz, TL ; Klein - Schwartz, W ; White, S ; Cobaugh, DJ ; Youniss, J ; Omslaer, JC ; Drab, A ; Benson, BE ( Sep 2001 ). `` 2000 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System ''. The American journal of emergency medicine. 19 ( 5 ) : 337 -- 95. doi : 10.1053 / ajem. 2001.25272. ISSN 0735 - 6757. PMID 11555795. Jump up ^ Starko, KM ( 1 November 2009 ). `` Salicylates and pandemic influenza mortality, 1918 - 1919 pharmacology, pathology, and historic evidence ''. Clinical Infectious Diseases. 49 ( 9 ) : 1405 -- 10. doi : 10.1086 / 606060. PMID 19788357. External links Classification V T D ICD - 10 : T39. 0 ICD - 9 - CM : 965.1 External resources MedlinePlus : 002542 eMedicine : emerg / 514 Wikimedia Commons has media related to Aspirin. Reingardiene, D ; Lazauskas, R ( 2006 ). `` ( Acute salicylate poisoning ) ''. Medicina ( Kaunas, Lithuania ). 42 ( 1 ) : 79 -- 83. PMID 16467617. Poisoning Toxicity Overdosing ( T36 -- T65, 960 -- 989 ) History of poison Toxicology Inorganic Metals Toxic metals Beryllium Cadmium Lead Mercury Nickel Silver Thallium Tin Dietary minerals Chromium Cobalt Copper Iron Manganese Zinc Metalloids Arsenic Nonmetals Sulfuric acid Selenium Chlorine Fluoride Organic Phosphorus Pesticides Aluminium phosphide Organophosphates Nitrogen Cyanide Nicotine Nitrogen dioxide poisoning CHO alcohol Ethanol Ethylene glycol Methanol Carbon monoxide Oxygen Toluene Pharmaceutical Drug overdoses Nervous Anticholinesterase Aspirin Barbiturates Benzodiazepines Opioids Paracetamol Tricyclic antidepressants Cardiovascular Digoxin Dipyridamole Vitamin poisoning Vitamin A Vitamin D Vitamin E Biological Fish / seafood Ciguatera Haff disease Ichthyoallyeinotoxism Scombroid Shellfish poisoning Amnesic Diarrhetic Neurotoxic Paralytic Other vertebrates amphibian venom Batrachotoxin Bombesin Bufotenin Physalaemin birds / quail Coturnism snake venom Alpha - Bungarotoxin Ancrod Batroxobin Arthropods Arthropod bites and stings bee sting / bee venom Apamin Melittin scorpion venom Charybdotoxin spider venom Latrotoxin / Latrodectism Loxoscelism tick paralysis Plants / fungi Cinchonism Ergotism Lathyrism Locoism Mushrooms Strychnine including venoms, toxins, toxicants, foodborne illnesses. Retrieved from `` https://en.wikipedia.org/w/index.php?title=Salicylate_poisoning&oldid=831759801 '' Categories : Aspirin Poisoning by drugs, medicaments and biological substances Hidden categories : Webarchive template wayback links Infobox medical condition ( new ) RTT RTTEM Talk Contents About Wikipedia Italiano עברית ଓଡ଼ିଆ Português Svenska 中文 Edit links This page was last edited on 22 March 2018, at 02 : 23. Text is available under the Creative Commons Attribution - ShareAlike License ; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia ® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. About Wikipedia

Question: what dose of salicylate can cause severe toxicity in a patient
Answer: 300–500 mg/kg