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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

General approach:

  • elimination - gastric lavage with suitable airway protection should be considered up to 24 hours after ingestion. In children, consider emetics unless unconscious, in which case, perform lavage
  • give activated charcoal, 50 g, down lavage tube after lavage, or orally after emesis
  • take bloods for full blood count and electrolytes, with salicylate and glucose levels, and arterial blood gases
  • ensure adequate fluids / electrolytes with special attention to the need for:
    • intravenous potassium to prevent hypokalaemia
    • intravenous dextrose to prevent hypoglycaemia.
    • intravenous vitamin K to correct hypothrombinaemia
  • monitor urine output with urinary catheter
  • ideally, dehydration should be corrected with the aid of central venous pressure measurements because of the risk of cerebral and pulmonary oedema

Subsequent management depends on the degree of poisoning:

  • mild poisoning - adequate treatment is provided by fluid and electrolyte replacement
  • moderate poisoning - requires forced alkaline diuresis. This is at levels of salycilate of 500 mg per litre and over.
  • severe poisoning, levels of 750 mg per litre and over - consider for haemodialysis or haemoperfusion. May also require intermittent positive pressure ventilation and pulmonary artery wedge pressure measurement

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