More than 200 products contain salicylates. Bismuth subsalicylate is an ingredient in Pepto-Bismol. Oil of wintergreen (methyl salicylate) used in BENGAY is highly toxic.
Salicylates increase ATP production which leads to metabolic acidosis.
Acute toxicity
Mild toxicity at 150 mg/kg – nausea, vomiting, dizziness, and tinnitus.
Moderate at 250 mg/kg – tachypnea, hyperpyrexia, sweating, agitation.
Severe at 500 mg/kg – metabolic acidosis, hypotension, renal failure, seizures.
Chronic toxicity at 100 mg/kg per day for 2 or more days – confusion, hallucinations, GI irritation leads to nausea, vomiting, and hematemesis, hypoglycemia, renal failure.
DX: Obtain a serum salicylate level initially and every 4 hours until the concentration has peaked (may be 12-18 hours for enteric-coated tablets).
Initial Management:
Activated charcoal initially and repeated, gastric lavage only if patient presents within 1 hour and > 500 mg/kg.
Systemic/urinary alkalization by adding 100 mEq of sodium bicarbonate to each liter of IVF and infusing at 200-300 ml/hr.
Hemodialysis for severe toxicity.
Benzodiazepines to treat seizure activity.