The acidic effects of salicylates also contribute to the associated acidosis. This causes heat production and pyrexia and increased lactic acid production, resulting in metabolic acidosis. Metabolisation of salicylates then causes uncoupling of oxidative phosphorylation, resulting in anaerobic metabolism.
In moderate/severe toxicity, salicylates stimulate the cerebral medulla, leading to hyperventilation and respiratory alkalosis. In higher doses, the pharmacodynamics of salicylate poisoning leads to a mixed respiratory alkalosis and metabolic acidosis. They can also cause ototoxicity through a multifactorial process, involving reduced cochlear blood flow secondary to vasoconstriction and changes to cochlear cells. In mild toxicity, salicylates directly irritate the gastric lining. Many non-prescription aspirin-containing products are available, and many cold and flu remedies also contain aspirin, increasing the risk of patients unknowingly exceeding the safe dose. Incorrect dosing in children and the elderly may also result in overdose. With the widespread use of salicylates, accidental ingestion of more than the recommended dose is common. Exploring the intention of an overdose is a key part of assessing a patient’s psychological state and associated risk. Selected antacids and antidiarrhoeal medicationsĪn intentional overdose can be a means of causing self-harm or a suicide attempt.
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