How is salicylate toxicity diagnosed?

Updated: Jun 06, 2020
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Timothy E Corden, MD  more...
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Answer

Initial and serial salicylate levels are important in the evaluation of salicylate toxicity. The absolute level should not detract from the importance of careful and repeated clinical evaluation. Immediately begin therapy in symptomatic patients. Do not wait for the salicylate levels to return from the laboratory.

If managing an acute or acute-on-chronic ingestion, repeat the salicylate serum level test every 2 hours until the salicylate level falls. If the levels increase, consider the possibility that a sustained-release preparation was ingested or that a concretion in the GI tract has formed.

The therapeutic range of salicylate is 15-30 mg/dL. Patients are often symptomatic at salicylate concentrations higher than 40-50 mg/dL. Patients with salicylate concentrations approaching or exceeding 100 mg/dL usually have serious or life-threatening toxicity. Patients with chronic poisoning who have levels of 60 mg/dL or greater often have serious toxicity.

One cautionary note is to always confirm the units of measurement with the laboratory. Traditional units are milligrams per deciliter; however, many laboratories report salicylate concentrations in milligrams per liter or micrograms per milliliter, both of which differ by a factor of 10 from the traditional units. For example, a salicylate concentration of 100 mg/dL is seriously toxic, but a concentration of 100 mg/L is subtherapeutic. A concentration of 100 mg/L is equal to a concentration of 10 mg/dL.


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