What is the role of salicylic acid in the pathogenesis of metabolic acidosis?

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Salicylic acid ionizes to salicylate and H+ ion with increasing pH; at a pH of 7.4, only 0.004% of salicylic acid is nonionized, as follows:

Salicylic acid (HS)↔salicylate (S) + H+ (H+)

HS is lipid soluble and can diffuse into the CNS; with a fall in pH, more HS is formed. The metabolic acidosis thus increases salicylate entry to the CNS, leading to respiratory alkalosis and CNS toxicity.

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