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Salicylates Poisoning

(see full publication)

 

General Recommendation

  • ECTR is recommended in severe salicylate poisoning (1D)

 

Indications

ECTR is recommended if ANY of the following are met:

  • If [salicylate] > 7.2 mmol/L (100 mg/dL) (1D)

  • If [salicylate] > 6.5 mmol/L (90 mg/dL) in the presence of impaired kidney function (1D)

  • In the presence of altered mental status (1D)

  • In the presence of new hypoxemia requiring supplemental oxygen (1D)

 

If standard therapy (supportive measures, bicarbonate, etc.) fails (1D), ECTR is suggested if any of the following are met:

  • If [salicylate] > 6.5 mmol/L (90 mg/dL) (2D)

  • If [salicylate] > 5.8 mmol/L (80 mg/dL) in the presence of impaired kidney function (2D)

  • If the systemic pH is ≤ 7.20  (2D)

 

Cessation of ECTR is indicated if:

  • clinical improvement is apparent (1D) and

  • [salicylate] < 1.4 mmol/L (19 mg/dL (1D) or ECTR has been performed for a period of at least 4-6 h when salcylate concentrations are not readily available (2D)

 

Choice of ECTR

  • Intermittent HD is the preferred modality in patients with salicylate poisoning (1D)

  • The following are acceptable alternative if HD is not available:

    • Intermittent HP (1D)

    • CRRT (3D)

    • Exchange transfusion in neonates (1D)

  • Miscellaneous: It is recommended to continue intravenous bicarbonate therapy between ECTR sessions (1D).