Patient handout

Salicylate (aspirin) overdose

PRODUCTION

1. Your condition

This handout is for salicylate (aspirin) overdose. Your care team identified this based on: acute or chronic salicylate / aspirin ingestion [aact 2020; extrip 2015].

Other reasons your team may use this plan: detectable salicylate level [extrip 2015]; mixed metabolic acidosis + respiratory alkalosis [aact 2020]; tinnitus + hyperventilation cluster (classic) [acmt 2023].

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
normal_saline_or_LR	20 mL/kg IV bolus, then maintenance	IV	bolus + continuous	Salicylate causes profound volume depletion via insensible losses, vomiting, osmotic diuresis; volume restoration is foundational (AACT 2023)
potassium_chloride	20-40 mEq IV per dose; targets K+ 4.0-4.5	IV	PRN q1-2h titrated	Hypokalemia BLOCKS urinary alkalinization (kidney swaps K for H+ — must replete K first) (AACT 2023)
dextrose_50	25-50 g IV bolus then D5 or D10 infusion	IV	bolus + continuous	CNS glucose depletion despite normal serum glucose; D50 indicated for any AMS

Plan: Salicylate — urinary alkalinization + electrolyte/glucose support + dialysis decision (AACT 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Salicylate level >100 mg/dL in acute ingestion (or >90 mg/dL in chronic) [EXTRIP 2015](life-threatening)
Arterial pH <7.2 OR persistent acidosis despite adequate NaHCO3 [EXTRIP 2015](life-threatening)
Altered mental status, seizure, or signs of cerebral edema [EXTRIP 2015](life-threatening)
Non-cardiogenic pulmonary edema on CXR (ARDS pattern) [EXTRIP 2015](life-threatening)
Acute kidney injury OR cannot achieve urine output despite resuscitation OR pre-existing renal failure [EXTRIP 2015]
Cannot deliver adequate NaHCO3 due to volume overload, CHF, or anuria [EXTRIP 2015]
Pediatric ingestion of methyl salicylate (oil of wintergreen) — even small volumes are lethal [ACMT 2023](life-threatening)

5. Follow-up

Psych safety plan, PCP med reconciliation (chronic ASA dose review) [ACMT 2023], social work, nephrology if AKI

6. Sources

Guideline: ACMT management priorities in salicylate toxicity + EXTRIP extracorporeal treatment recommendations + salicylate activated-charcoal/bicarbonate evidence