Salicilato

Emerg Med Clin N Am 25 (2007) 333–346

Emergency Department Management of the Salicylate-Poisoned Patient
Gerald F. O’Malley, DOa,b,c,d,* a Division of Toxicology, Albert Einstein Medical Center, 5501 Old York Road,
Philadelphia, PA 19141, USA b Thomas Jefferson University Hospital, Philadelphia, PA 19141, USA c Children’s Hospital of Philadelphia, Philadelphia, PA 19141, USA d Philadelphia Poison Control Center, Philadelphia, PA 19141, USA

The term salicylate refers to any of a group of chemicals that are derived from salicylic acid. The best known is acetylsalicylic acid (aspirin). Acetylsalicylic acid is metabolized to salicylic acid (salicylate) after ingestion.
The salicylates originally were derived from salicin, the active ingredient in willow bark, which Hippocrates used 2500 years ago for treating pain and fever [1,2]. Salicylates also occur naturally in many plants such as strawberries, almonds, and tomatoes [3].
Poisoning by aspirin is common and is under-represented in poison center data, because it is often not recognized [4–6]. The in-hospital mortality for unrecognized chronic aspirin poisoning is reportedly three times higher than if the diagnosis is made in the emergency department [7]. Familiarity with the clinical presentation during the various stages of acute and chronic aspirin poisoning is important for the practice of emergency medicine. The most challenging aspect of the clinical evaluation and management of the aspirin-poisoned patient may be recognition of the subtle signs and symptoms of chronic, nonintentional aspirin overdose (Box 1).

Epidemiology
Salicylate poisoning continues to be an important overdose that frequently presents to emergency departments [8–10]. There were over 21,000

* Department of Emergency Medicine, Albert Einstein Medical Center, 5501 Old York
Road, Philadelphia, PA 19141.
E-mail address: [e-mail]
0733-8627/07/$ - see front matter Ó 2007 Elsevier Inc. All rights