Assessing severity of salicylate toxicity

	Mild (or early) toxicity	Moderate (or middle) toxicity	Severe (or late) toxicity
Symptoms	Tinnitus Nausea	Vomiting	Confusion
Signs	Tachypnea Mild hyperpnea and/or tachycardia may start to develop	Mild hyperthermia Tachycardia Hyperpnea Diaphoresis	Hyperthermia Cerebral edema Pulmonary edema Hypotension
Mental status	Normal	Normal Mild disorientation may start to develop	Altered mentation Disorientation Agitation Coma Seizures
Serum salicylate concentration^*	30 to 50 mg/dL (2.2 to 3.6 mmol/L)	50 to 90 mg/dL (3.6 to 7.2 mmol/L)	Acute toxicity: >90 mg/dL (>6.5 mmol/L) Chronic toxicity: >60 mg/dL (>4.3 mmol/L)
Blood pH	Normal or alkalotic (>7.45)	Alkalotic (>7.45)^¶	Acidotic (<7.3)
Urine pH	>5	<5	<5

* The serum salicylate concentration often does not correlate with or lags behind development of clinical symptoms. A patient with chronic salicylate toxicity can have severe signs and symptoms at therapeutic salicylate concentrations.

¶ The blood pH can occasionally be in the normal range (7.35 to 7.45) if metabolic acidosis is overwhelming the primary respiratory alkalosis.

Graphic 140948 Version 2.0

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Assessing severity of salicylate toxicity