Snapshot A 20-year-old man presents to the emergency room after an intentional overdose of aspirin. He reports ingesting an unknown amount of aspirin about 30 minutes prior to presentation with the intention of committing suicide. However, he changed his mind and asked to be saved. He reports some nausea, vomiting, and ringing in his ears. He is started on intravenous hydration and given activated charcoal. Introduction Clinical definition a constellation of symptoms resulting from toxicity or overdose from salicylates, most commonly aspirin Epidemiology demographics patients taking chronic pain medications Etiology intentional overdose accidental overdose Pathogenesis salicylates have multiple effects on the body hyperventilation and early respiratory alkalosis login to view 1 more bullet later metabolic acidosis, resulting in mixed metabolic acidosis-respiratory alkalosis login to view 2 more bullets tinnitus login to view 1 more bullet acute respiratory distress syndrome login to view 1 more bullet renal insufficiency login to view 1 more bullet increased bleeding time login to view 1 more bullet Prognosis depends on the severity of toxicity severe cases may be fatal Presentation Symptoms tinnitus nausea vomiting fever lethargy seizure or coma (in cases of severe poisoning) Physical exam tachypnea tachycardia hyperthermia Studies Labs arterial blood gas to evaluate for acidosis or alkalosis serum salicylate level to confirm the diagnosis measure every 3 hours as toxicity can be delayed chemistry panel with liver function tests to assess renal and hepatic function Making the diagnosis based on clinical presentation and laboratory studies especially if patients present with tinnitus, anion gap metabolic acidosis, and elevated serum salicylate levels Differential Acetaminophen overdose distinguishing factors hepatic failure no tinnitus or acid-base derangement the antidote is N-acetylcysteine Treatment Conservative supportive care indication login to view 1 more bullet modalities login to view 1 more bullet Medical activated charcoal indications login to view 2 more bullets sodium bicarbonate indications login to view 3 more bullets Non-operative dialysis indication login to view 1 more bullet Complications Renal failure