Hemodialysis is recommended for acute salicylate poisoning

May 19, 2015, American College of Emergency Physicians

The best remedy for severe salicylate poisoning is hemodialysis, according to a comprehensive systematic review of the medical literature published on Friday in Annals of Emergency Medicine. Salicylate is an active ingredient in aspirin as well as hundreds of over-the-counter medications, and contributes to approximately 20,000 accidental or intentional poisonings and nearly 30 deaths reported to US Poison Control Centers every year.

"Our workgroup unanimously recommend extracorporeal treatment, such as dialysis, as treatment for severe salicylate ," said lead study author Robert S. Hoffman, MD, Director of the Division of Medical Toxicology of New York University School of Medicine in New York, N.Y. "Salicylate poisoning is a medical emergency and is easily underestimated. It causes significant harm and even death, which is why it requires prompt, aggressive treatment with dialysis."

Hemodialysis is recommended for changes in mental status, new-onset hypoxemia, failure of supportive therapy and very elevated salicylate concentrations regardless of clinical status. Unlike patients with chronic salicylate poisoning, patients with acute salicylate poisoning often appear relatively well in the hours shortly after overdose, despite substantially elevated salicylate concentrations.

The EXTIRP Workgroup, comprised of international toxicology experts, reviewed 83 articles about salicylate poisoning, including two clinical studies, one controlled clinical trial, animal studies and 80 case reports or series.

"Extracorporeal treatment is the only treatment that convincingly and rapidly reduces the burden of circulating salicylate," said Dr. Hoffman. "It does so efficiently and reduces the delivery of salicylate to the brain."

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More information: "Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations from the EXTIRP Workgroup", Annals of Emergency Medicine, 2015.

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