Salicylate poisoning
Dose-based risk, the mixed respiratory alkalosis and high anion gap acidosis, serial levels for delayed absorption, chronic toxicity mistaken for sepsis in older people, urinary alkalinisation with potassium, EXTRIP criteria for haemodialysis, and the danger of intubation.
Tier 2Condition
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At a glance
- Salicylate uncouples oxidative phosphorylation and stimulates the respiratory centre. The result is a mixed respiratory alkalosis and high anion gap metabolic acidosis.
- Early features: tinnitus, vomiting, sweating, tachypnoea.
- Absorption is delayed: repeat levels every 2 to 4 hours until two consecutive levels fall.
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Sources
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update: revised advice on when to start sodium bicarbonate in salicylate poisoning)AU/NZTherapeutic Guidelines Limited, 2024
- Poisons Information Centre (13 11 26)AU/NZNSW Poisons Information Centre, Sydney Children's Hospitals Network
- Juurlink DN et al. Extracorporeal treatment for salicylate poisoning: systematic review and recommendations from the EXTRIP workgroup. Ann Emerg Med 2015;66:165-81Annals of Emergency Medicine, 2015
- McDonald BA et al. Tracheal intubation and mechanical ventilation in adults with severe salicylate poisoning. J Emerg Med 2024;67:e268-76Journal of Emergency Medicine, 2024
- Weigel B et al. Urinary alkalinization for salicylate poisoning is infrequently measured nor achieved. Am J Ther 2025;32:e322-5American Journal of Therapeutics, 2025
- Last updated
- 14 November 2026
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