Management

General approach:

• elimination - gastric lavage with suitable airway protection should be considered up to 24 hours after ingestion. In children, consider emetics unless unconscious, in which case, perform lavage
• give activated charcoal, 50 g, down lavage tube after lavage, or orally after emesis
• take bloods for full blood count and electrolytes, with salicylate and glucose levels, and arterial blood gases
• ensure adequate fluids / electrolytes with special attention to the need for:
  • intravenous potassium to prevent hypokalaemia
  • intravenous dextrose to prevent hypoglycaemia.
  • intravenous vitamin K to correct hypothrombinaemia
• monitor urine output with urinary catheter
• ideally, dehydration should be corrected with the aid of central venous pressure measurements because of the risk of cerebral and pulmonary oedema

Subsequent management depends on the degree of poisoning:

• mild poisoning - adequate treatment is provided by fluid and electrolyte replacement
• moderate poisoning - requires forced alkaline diuresis. This is at levels of salycilate of 500 mg per litre and over.
• severe poisoning, levels of 750 mg per litre and over - consider for haemodialysis or haemoperfusion. May also require intermittent positive pressure ventilation and pulmonary artery wedge pressure measurement