A stable patient with declining serum levels indicates decreasing absorption. If you have a history that supports salicylate poisoning, the actual serum salicylate concentration does not matter as much as the trend in serially checked levels and the correlation between changing levels and the patient’s clinical status. Serum electrolytes (Na++, K+, Cl-, HCO3-, Ca++) Renal function panel (blood urea nitrogen (BUN) and creatinine)Ĭoagulation studies (prothrombin time, partial thromboplastin time) Table 1: Recommended laboratory studies in acute salicylate poisoning For ALL patients (especially if symptomatic)įor those with MODERATE to SEVERE poisoning, add on: mg/dL, mmol/L), as they differ between sites.
Important: Be familiar with your laboratory’s concentration units (e.g. The number alone won’t provide enough information if the patient is well-appearing (unless it’s extremely elevated, say > 100 mg/dL, in which case you should consult with nephrology to discuss hemodialysis early). While the Done nomogram is available and well-intentioned, it is NOT a reliable tool in determining level of toxicity based on time of ingestion and drug level, so you should consider the salicylate level in the context of the patient’s whole clinical picture. Serum salicylate concentration: Check it early, check it oftenĬheck a serum salicylate level with your initial labs (Table 1). 3 While not an official clinical guideline, it highlights some important concepts to consider when working up and treating patients after a significant salicylate exposure, and we’ll review five major concepts here and hopefully answer some questions that may cross your mind on shift. 2 The American College of Medical Toxicology (ACMT) recently published a guidance document on management priorities in salicylate toxicity, and it’s definitely worth a read. Significant toxicity occurs when a large amount of salicylate saturates the body’s protein-binding capacity and leaves free salicylate in the serum.
1 Patients can present with a wide variety of complaints including tinnitus, dyspnea, vomiting, confusion, and coma.
Salicylate is among the top 25 substances that cause the greatest number of overdose fatalities in the United States.
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