Managing Salicylate Poisoning in Children

Alkaline Diuresis in Treatment of Aspirin Poisoning

“…Hg and standard bicarbonate 22.5 mEq/l. These figures are in accord with those published by Oliver and Dyer (1960) and by Whitten et al (1961).…”

“…These results compare favourably with those obtained with exchange transfusion and haemodialysis (Oliver and Dyer, 1960;Whitten, Kesaree, and Goodwin, 1961).…”

“…We have taken as an index of efficiency in treatment the rate at which the serum salicylate concentration fell, and agree with Whitten et al (1961) that this is the most satisfactory measurement with which to compare different methods of treatment.…”

Salicylate Intoxication

“…Urine alkalinization alone is more effective than FD or FAD, and it avoids the potential complication of fluid overload that may result from FD, especially in the elderly or those with marginal cardiac performance [5]. Published recommended indications for initiating urine alkalinization include various clinical scenarios or serum salicylate concentrations of 30 to 60 mg/dL [46,87,88,94–100]. Initiating urinary alkalinization would also be appropriate in patients presenting with any signs or symptoms of salicylism (unless the patient is clinically fluid overloaded) when serum salicylate levels are not readily available.…”

“…Concerns regarding use of NaHCO 3 include worsening of alkalemia in patients who already have respiratory alkalosis and the possibility of inducing hypernatremia, hypokalemia, fluid overload, and congestive heart failure [38,94,95,99,101,102]. Complications can be minimized by careful monitoring urine and systemic pH, keeping the urine pH at 8, and not to exceed a blood pH of 7.55 [3,40,88,99].…”