Metabolic acidosis
ICD-10 E87.2 · ICD-11 5C73

Treatment of Metabolic Acidosis in Salicylate (Salicylic Acid) Poisoning

Metabolic acidosis arising from salicylate poisoning presents a combined toxicological and acid-base emergency. The persistence of the offending agent drives ongoing acid production, making toxin removal a central treatment priority alongside acid-base correction.

Clinical Scenario

Metabolic acidosis associated with salicylate (salicylic acid) poisoning. This scenario involves a patient with documented salicylate exposure in whom significant acid-base derangement has developed, requiring a structured and time-sensitive clinical response.

Approach — partial overview

Management in this setting involves initiation of renal replacement therapy, with a specific preferred extracorporeal modality, combined with ongoing alkalinization maintained between sessions. Treatment continues until complete elimination of salicylate is achieved.

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References

DOI: 10.1053/j.ajkd.2019.01.036

The experts suggest administering sodium bicarbonate in the therapeutic management of salicylate poisoning, whatever the pH value (EXPERT OPINION).

In metabolic acidosis associated with salicylic acid poisoning, the experts suggest initiation of renal replacement therapy when there is neurological involvement and/or if the salicylic acid concentration is above 6.5 mmol/L (90 mg/dL) and/or if the pH is less than or equal to 7.20 (EXPERT OPINION).

They also concluded that salicylic acid is highly dialyzable and that intermittent hemodialysis is the preferred modality.

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