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Salicylate poisoning occurs from overdose of aspirin or other salicylate-containing medications, presenting with altered mental status, tinnitus, and metabolic acidosis. It can be acute from intentional overdose or chronic from therapeutic misuse, particularly in elderly patients. Early recognition and treatment are critical as severe cases can progress to pulmonary edema, cerebral edema, and death.
Salicylates uncouple oxidative phosphorylation in mitochondria, leading to increased oxygen consumption, heat production, and lactate formation. They directly stimulate the respiratory center causing hyperventilation and respiratory alkalosis, followed by metabolic acidosis from impaired cellular metabolism. Salicylates also interfere with glucose metabolism, causing CNS glucose depletion despite normal serum glucose levels.
Diagnosis requires high clinical suspicion as symptoms can mimic other conditions like sepsis or diabetic ketoacidosis. The classic triad of altered mental status, tinnitus, and hyperventilation with mixed acid-base disorder (respiratory alkalosis with metabolic acidosis) should prompt salicylate level measurement. Treatment focuses on enhancing elimination through urinary alkalinization and hemodialysis in severe cases, while managing complications like hyperthermia and cerebral edema.