Hypokalemia requires aggressive repletion - this differentiates from DKA which tends to have hyperkalemia or normokalemia at initial presentation.Hyperglycemia in periphery (CSF will have low glucose due to CNS hypermetabolic state).Acetaminophen level (possible co-ingestant).Propylene glycol infusions for lorazepam and phenobarbital.Sepsis, shock, liver disease, CO, CN, metformin, methemoglobin.Higher morbidity ( pulmonary edema, seizures, renal failure) and mortality rate compared with acute toxicityĭifferential Diagnosis Anion gap metabolic acidosis.Usually neurologic abnormalities, especially in elderly.Due to inhibition of prostaglandin synthesis, can lead to premature closure of the ductus arteriosus.There can be displacement of bilirubin from protein binding sites allowing it to cross the blood brain barrier, which can lead to kernicterus.

Due to fetal inability to hyperventilate leads to worsening acidosis.Un-ionized salicylate cross the placenta due to higher fetal pH, where it becomes ionized and accumulates in the fetus.Increased fetal morbidity and mortality.Due to increased pulmonary vascular permeability.Salicylate toxicity increases CNS utilization of glucose, serum glucose levels may not reflect CNS levels.Direct toxicity of salicylate species in the CNS.As pH drops more ASA is uncharged able to cross BBB.Normal AG does not exclude ASA toxicity in patient with an unknown ingestion (mixed picture).Leads to compensatory alkaluria: urinary excretion of potassium and sodium bicarb.If have respiratory acidosis, consider: pulmonary edema, co-ingestion of respiratory depressant or fatigue.Activates respiratory center of medulla.May cause metabolic alkalosis (contraction alkalosis).As level rises, switches from hepatic to renal clearance (slower).Uncouples oxidative phosphorylation → increased metabolic rate and hyperthermia Oil of Wintergreen is very concentrated - 5mL contains equivalent of 7.5g of aspirin.

Aspirin toxicity antidote