![]() Metabolic acidosis reflects increases in ketoacid, salicylic acid, and lactic acid.(2) Second, an anion-gap metabolic acidosis develops as well, creating a mixed picture. ![]() Salicylate affects the medulla directly, increasing respiratory drive.(1) First finding is respiratory alkalosis.Nonetheless, the classic pattern of findings is as follows: Note also that patients with co-ingestion may not manifest with classic acid/base patterns (e.g., aspirin plus opioids may not lead to a respiratory alkalosis). Acid-base status can suggest salicylate toxicity, but cannot exclude it.⚠️ If any doubt exists, call nephrology & poison control for help early & often.(5) Salicylate >80 mg/dL (5.8 mM) with renal dysfunction and despite fluid resuscitation/alkalinization.(4) Salicylate >90 mg/dL (6.5 mM) with renal dysfunction, or despite fluid resuscitation/alkalinization.(1) Altered mental status or pulmonary edema.Aggressively replete potassium to maintain >4-4.5 mEq/L (it will drop).Follow with isotonic bicarbonate (150 mEq/L) as maintenance fluid at ~200 ml/hr.Start with 2-3 amps (50 mEq each) of bicarb given as a slow push over ~10 min.Indicated if salicylate >40 mg/dL (>2.9 mM) and/or symptoms (i.e., most significant intoxications).DO NOT give normal saline (this worsens acidosis).Salicylate level: Cycle until 7.5 Use balanced crystalloid (e.g. ![]()
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