Salicylates
Summary
Salicylates (aspirin) cause toxicity by uncoupling oxidative phosphorylation, leading to mixed respiratory alkalosis and anion gap metabolic acidosis. Present with tachypnea, tinnitus, and altered mental status.
Detail
Salicylates stimulate the medullary respiratory center causing hyperventilation (respiratory alkalosis) while also uncoupling oxidative phosphorylation, producing lactate and ketone accumulation (metabolic acidosis). This mixed acid-base disturbance is pathognomonic. Late phase: cerebral edema, seizures, pulmonary edema. Treatment: IV sodium bicarbonate to alkalinize serum and urine, promoting renal excretion. Hemodialysis for severe cases.
Sources
- First Aid for the USMLE Step 1
- Goldfrank's Toxicologic Emergencies
- Harrison's Principles of Internal Medicine
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