Aspirin / Salicylate OverdoseICU / resuscitation

Took 60 tablets of aspirin 325 mg; tinnitus, vomiting, RR 32; VBG pH 7.36, PaCO₂ 22, HCO₃ 12 (mixed respiratory alkalosis + anion-gap acidosis); salicylate 62 mg/dL

• Confusion or seizures
• pH ≤7.20
• Rising level
• Pulmonary oedema

• DKA
• Sepsis
• Toxic alcohols
• Lactic acidosis
• Meningitis (fever + confusion)

• Admit: Symptomatic or level >30 mg/dL
• ICU: Altered mental state, pH ≤7.20, level >80–90 mg/dL, pulmonary oedema
• Dialysis: EXTRIP criteria above

• Mixed respiratory alkalosis + high anion-gap acidosis in an adult = think salicylate.
• A "normal" pH may hide severe toxicity; confusion is a dialysis indication.
• Chronic toxicity in the elderly presents as confusion with lower levels — lower threshold for dialysis.

• Intubate without matching the patient's high minute ventilation
• Rely on a single salicylate level
• Let K⁺ fall during alkalinisation
• Use acetazolamide to alkalinise urine (worsens acidosis)

• Intubation without ventilator matching
• Single levels
• Hypokalaemia
• Late dialysis

ICU/HDU with early nephrology; psychiatry before discharge.