Key messages

• The fatal adult dose of aspirin is 500 mg/kg; symptoms of toxicity may be minimal even in severe cases.

• Common early features of salicylate overdose are irritability, tinnitus, hyperventilation, nausea, vomiting, and abdominal pain.

• Respiratory alkalosis, metabolic acidosis, ketosis, hypoglycemia, and hyperglycemia may all occur.

• Gastric lavage may be performed up to 12 h after ingestion in large aspirin overdoses because, owing to the insolubility of salicylate in gastric acid, concretions may form within the stomach.

• Hemodialysis is indicated if there are severe metabolic changes, or if the salicylate level is over 800 mg/l (5.76 mmol/l) after rehydration.

• If the salicylate level is over 600 mg/l (4.32 mmol/l) urinary alkalinization (intravenous sodium bicarbonate 8.4 per cent) should be used to maintain a urine pH over 7.5.

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