salicylate toxicity

choline salicylate
present in oil of wintergreen, teething gels - potential source of chronic toxicity

	Headline
Clinical presentation	Classically: Nausea, vomiting, tinnitus Meningitis mimic - Delirium, hyperthermia, cerebral oedema Pneumonia mimic - tachypnoea, pulmonary oedema Sepsis mimic - acidosis, shock
Pathogenesis	- respiratory alkalosis - stimulation of respiratory centres - metab/lactic acidosis - uncoupling of oxidative phosphorylation - cerebral oedema, pulmonary oedema
Pharmacokinetics	Absorption Distribution Metabolism conjugation, t½ 2-4h Elimination
Diagnostic investigations	Salicylate serum levels - 15-30 mg/dL (1-2.2 mM): Therapeutic. >40-50 mg/dL (>2.9-3.6 mM): Intoxication in most patients However, harm comes from non-ionised form = lower serum pH → lower level required to cause toxicity
Management	A/B: be very very wary of tubing - generic vent settings takes away resp compensation for metab acidosis D: E: ↑ clearance - Haemodialysis or urinary alkalinisation (adequate hydration + potassium replacement)

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