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Question: Tox

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You are seeing a 15 year old who took a handful of aspirin in a suicide attempt. The salicylate level at 3 hours post-ingestion is 20 mg/dL. Toxicity generally begins at levels of 30 mg/dL and higher. You are certain there were no co-ingestants and the patient’s vital signs, physical exam, metabolic panel, and EKG are normal. 

What should you do next?
12 votes

pemsou5_wp • July 13, 2021

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  1. Kelly July 14, 2021 - 3:15 am Reply

    D) Repeat the salicylate level every 2 hours until it is downtrending
    The therapeutic range of salicylate is 15-30 mg/dL. Toxicity begins at 30 mg/dL, and serious toxicity at 60 mg/dL. It is important to carefully check the units your lab uses, as some labs report in mg/L rather than mg/dL. There are many reasons for possible delayed aspirin toxicity after an initial non-toxic or even undetectable level, including bezoar/concretion formation, aspirin-induced gastric pylorospasm and delayed gastric emptying, sustain-release or enteric-coated formulations, and patient variation in serum protein levels, pH, and elimination factors. Levels in overdose may also not peak for 4-6 hours post-ingestion. For these reason, salicylate levels should be repeated every two hours until downtrending.

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