5 Like similar volunteer studies in other drugs it does not accurately reflect the effect of treatment regimens in poisoned patients, but none the less taken with the other evidence shown in figure 1, it provides some rationale to support the use of activated charcoal within one hour of an overdose. Prevention of further absorptionĪ study on volunteers taking 1.5 g aspirin comparing activated charcoal, emesis, and gastric lavage had several limitations salicylate elimination was followed up for only 24 hours, the analytical method used underestimated some salicylate metabolites, and plasma salicylate concentrations were not measured. There is no antidote to salicylate poisoning and management is directed towards preventing further absorption and increasing elimination of the drug in patients with features of moderate or severe intoxication. Further advice on the management of salicylate poisoning is also always available from a poisons centre (in the UK the single national number, 08, will connect you to your local poisons centre) It is a guide however, not a protocol and individual decisions will still need to be made for each patient. This evidence based flowchart has been developed to help guide decision making in salicylate poisoning. Once the severity of poisoning is recognised, management is a success story for clinical toxicology as over the past 40 years techniques to reduce the absorption of salicylate and increase its elimination have been developed. 4 The current problem is that because salicylate poisoning is not seen so commonly, through lack of familiarity, medical and nursing staff may underestimate the severity of poisoning or fail to administer sufficiently vigorous treatments early enough to prevent morbidity and mortality (NPIS data, not shown). 1– 3 Critically, in severe salicylate poisoning, delay in diagnosis was associated with a mortality of 15% compared with a much lower rate in those patients in whom early diagnosis and initiation of treatment was made. 1 Death can occur in 5% of patients who have such features of severe poisoning and is attributable to cardiac arrest or multiple complications after severe brain damage. Although the overall mortality in salicylate poisoning is low, such figures can be very deceptive as severe poisoning may cause metabolic acidosis, convulsions, coma, hyperpyrexia, pulmonary oedema, and renal failure.
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