Salicylate poisoning is a serious complication of aspirin overdose and is characterized by mixed respiratory alkalosis and increased anion gap metabolic acidosis.
Pathophysiology
- Early mixed respiratory alkalosis → ↑ anion gap metabolic acidosis
- Salicylates directly stimulate the respiratory center of the brain → hyperventilation → CO2 washout → primary respiratory alkalosis
- Disruption of mitochondrial oxidative phosphorylation → inhibition of TCA cycle and ATP production → accumulation of lactic acid and ketones → ↑ anion gap metabolic acidosis
- Fatigue impairs the ability to compensate for acidosis (via hyperventilation) → hemodynamic instability and end-organ damage
- ↑ Pulmonary capillary permeability → ARDS with pulmonary edema.
Clinical features
- Early symptoms: tinnitus, nausea, vomiting, tachypnea, hyperpnea
- Late symptoms: hyperthermia, agitation, delirium, seizures, noncardiogenic pulmonary edema
Diagnostics
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Treatment
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