Respiratory Alkalosis in Salicylate Poisoning When Urine Alkalinization Has Not Corrected Acidemia

This protocol addresses the management of respiratory alkalosis occurring in the context of salicylate poisoning — specifically after first-line measures have failed to achieve the required treatment goals.

Clinical Scenario

Salicylate poisoning can present with respiratory alkalosis alongside an increased anion gap metabolic acidosis. This acid-base combination is a key diagnostic signal and defines the target population for this protocol.

Previous Treatment — Goals Not Reached

Initial management with systemic acidemia correction and urine alkalinization did not achieve its targets: correction of systemic acidemia and an alkaline urine pH. This protocol represents the escalation step taken after that failure.

Next-Line Approach

When those initial goals are not met, management escalates to hemodialysis. The full indications, decision criteria, and clinical sequencing are detailed in the complete structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1053/j.ajkd.2023.02.004

Unexplained respiratory alkalosis, particularly in association with an increased anion gap metabolic acidosis, should prompt consideration of salicylate poisoning.

Hemodialysis is indicated at serum concentrations >80 mg/dL or in the setting of severe clinical toxicity.

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