Current Management of Salicylate-induced Pulmonary Edema

James K. Glisson, MD, PharmD; Telciane S. Vesa, MD; Mark R. Bowling, MD, FACP

Disclosures

South Med J. 2011;104(3):225-232. 

In This Article

Abstract and Introduction

Abstract

Salicylate-induced pulmonary edema (SIPE) can occur in both acute and chronic users of aspirin or salicylate products. The medical history, especially when it reveals the use of salicylates, is critical when considering this diagnosis. Unfortunately, the neurologic and systemic effects of salicylate toxicity may hinder the ability to obtain a reliable medical history. SIPE should be considered in patients who present with pulmonary edema and neurological changes, anion-gap metabolic acidosis, or possible sepsis. Some patients may be treated for "pseudosepsis" or other conditions, thereby delaying the diagnosis of salicylate intoxication. Misdiagnosis and possibly delayed diagnosis of SIPE can lead to a significant increase in morbidity and mortality. Serum and urine alkalinization by administration of intravenous sodium bicarbonate are commonly utilized therapeutic strategies. Finally, hemodialysis is a therapy which should be considered early in the course of treatment. The objective of this review was to emphasize the importance of rapid diagnosis and appropriate treatment in patients with SIPE, and summarize the current literature as it relates to the adult population.

Introduction

Salicylate-induced pulmonary edema (SIPE) is a complication of salicylate toxicity, which can be difficult to diagnose and treat. Significant mortality and morbidity may result from delayed diagnosis or misdiagnosis of SIPE. This review will discuss the limitations of the current literature on SIPE and guide practitioners on how to recognize and treat this uncommon condition.

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