MANAGEMENT OF SALICYLATE INTOXICATION

Poisoning with salicylic acid and its derivatives is a quite common ev ent, leading to possibly life-threatening complications. A case of fat al intoxication of a sixty-year old patient with acetylsalicylic acid is described and the therapeutic options are discussed. In acute poiso ning it is mandatory to initiate simple and effective measures first. This gives time for discussing and planning the more laborious procedu res. The initial treatment of salicylate poisoning is based on the pre vention of further absorption by a sufficiently large quantity of oral ly administered activated charcoal (approximately 1 g/kg b.w.). Given repeatedly, activated charcoal may enhance non-renal clearance of sali cylates. Intravenously administered sodium bicarbonate counteracts the metabolic acidosis. Moreover, bicarbonate therapy limits tissue distr ibution of the drug and enhances its renal excretion. The availability of glycine for salicyclic acid metabolism may be limited in poisoning because glycine has been used for forming the conjugation product sal icyluric acid. Glycine may be administered orally to overcome this bot tleneck. Gastric lavage has been proven to be of limited efficacy. Thi s efficacy is further diminished if gastric lavage is performed late a fter drug ingestion. When it is performed, however, activated charcoal should be administered before and after gastric lavage. Whenever the more simple treatment options fail, hemodialysis or hemoperfusion shou ld be additionally considered since these procedures are effective in removing salicylates from the body.