In the second serial of this topic- poisoning in MRCP, I am going to talk about salicylates poisoning. It is an important topic in MRCP Part 1 and 2 as well as in your clinical practice. The reason is simple, salicylates can be obtained easily because it can be found in aspirin .You certainly know many patients are on aspirin if you go to ward everyday and at one time, some doctors even suggested to put aspirin in our tap water!
Before we discuss common presentations of a patient with salicylates poisoning, we must know the pathophysiology of salicylates overdose. Salicylates stimulate the respiratory centre initially and cause respiratory alkalosis. However, salicylates also interfere with carbohydrate metabolism and lead to accumulation of lactic acid and lead to metabolic acidosis.
Symptoms of Toxicity ( ASPIRIM)
Acute renal failure- symptoms of acute renal failure
Salicylism- deafness, tinnitus, vomitting
Pulmonary edema or cerebral edema (confusion)
Increased temperature
Respiratory alkalosis- hyperpnoea
GI disturbances and haemorrahge
Metabolic acidosis
Signs of toxicity
Air hunger ( due to metabolic acidosis)
Hyperpnoea ( due to respiratory alkalosis)
Remember that initially, there is respiratory alkalosis but later patient will have metabolic acidosis
Interactions
Increases anticoagulation effect
Low dose of aspirin precipitates gout
Treatment
Gastric lavage
Forced alkaline diuresis
Haemodialysis is indicated in severe cases
Hope you know how to answer your MRCP questions about salicylates after this post!
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