May occur after a single dose of a large dose or with prolonged use. If a single dose is less than 150 mg / kg, acute poisoning is considered easy, 150-300 mg / kg - moderate and with higher doses - heavy.
Symptoms of an overdose from mild to moderate severity:
dizziness, tinnitus, hearing impairment, visual impairment, increased sweating (including profuse), nausea, vomiting, headache, confusion, tachypnea, hyperventilation, respiratory alkalosis.
Treatment: Provocation of vomiting, repeated intake of activated carbon, forced alkaline diuresis, restoration of water-electrolyte balance and acid-base state.
Symptoms of an overdose from medium to severe:
- respiratory alkalosis with compensatory metabolic acidosis;
- hyperpyrexia (extremely high body temperature);
- breathing disorders: hyperventilation, non-cardiogenic pulmonary edema, respiratory depression, asphyxia;
- disorders of the cardiovascular system: heart rhythm disturbances, lowering of blood pressure, suppression of cardiac activity, collapse;
- disturbance of water-electrolyte balance: dehydration, disturbance of kidney function from oliguria up to the development of renal failure, characterized by hypokalemia, hypernatremia, hyponatremia;
- impaired glucose metabolism: hyperglycemia, hypoglycemia (especially in children), ketoacidosis;
- noise in the ears, deafness;
- gastrointestinal bleeding;
- hematological disorders: from inhibition of platelet aggregation to coagulopathy, prolongation of prothrombin time, hypoprothrombinemia;
- neurological disorders: toxic encephalopathy and depression of the central nervous system (drowsiness, confusion, coma, convulsions).
Treatment: immediate hospitalization in specialized units for emergency therapy - gastric lavage, repeated administration of activated charcoal and laxatives alkalization urine (shown in the level of salicylates higher than 500 mg / l, provides an intravenous infusion of sodium carbonate - 88 mEq in 1 L of 5% glucose solution with rate of 10-15 ml / kg / h), the restoration of circulating blood volume and the induction of diuresis (achieved by the introduction of sodium hydrogen carbonate at the same dose and dilution was repeated 2-3 times); it should be borne in mind that intensive fluid infusion of the elderly can lead to pulmonary edema. It is not recommended to use acetosolamide for alkalinization of urine (can cause acidemia and enhance the toxic effect of salicylates). When carrying out alkaline diuresis, it is necessary to achieve pH values between 7.5 and 8.Hemodialysis is indicated at a level of salicylates in the blood plasma of more than 1000 mg / l, and in patients with chronic poisoning it is 500 mg / l and lower in the presence of indications (refractory acidosis, progressive deterioration, severe central nervous system damage, pulmonary edema and kidney failure) . With pulmonary edema, artificial ventilation of the lungs with a mixture enriched with oxygen is shown in the positive pressure mode at the end of the exhalation; To treat edema of the brain, hyperventilation and osmotic diuresis are used.
The greatest risk of developing chronic intoxication is observed in the elderly with more than 100 mg / kg / day for several days. In children and elderly patients, the initial signs of salicylism (nausea, vomiting, tinnitus, visual impairment, dizziness, headache, general malaise) are not always noticeable, so it is advisable to periodically determine the salicylate content in the blood plasma.