The association of hemodialysis and survival in intubated salicylate-poisoned patients

IntroductionSalicylate poisonings are common due to their multiple uses and wide availability. The variation of presenting symptoms contributes to inconsistent treatments in the emergency department. Patients with severe salicylate overdose require a high minute ventilation. Early in the course of an overdose, a patient will require hyperventilation. If they become too fatigued to compensate, mechanical ventilation may be needed. It can be impossible to recreate such a high minute ventilation with mechanical ventilation. This places patients at a high risk for decompensation and death. Hemodialysis is an effective elimination technique for salicylate overdose and should be considered early.MethodsAll salicylate cases reported to the Illinois Poison Center were reviewed from 2003-2014. All intubated patients with a salicylate level > 50 mg/dl were included for analysis. Survival was compared to measured serum salicylate level and the administration of hemodialysis.Results56 Cases were identified with an overall survival rate of 73.2% in patients with a serum salicylate level > 50 mg/dl. When patients did not receive hemodialysis, a peak salicylate level > 50 mg/dl had a 56% survival rate and 0% survival when the level was > 80 mg/dl. In the patients who received hemodialysis, a peak salicylate level > 50 mg/dl had a 83.9% survival rate and 83.3% survival when the level was > 80 mg/dl.ConclusionSurvival was decreased in these patients if hemodialysis was not performed. Mortality increases with the measured serum salicylate level. Timely hemodialysis for intubated salicylate overdose patients decreases mortality.