Salicylate level

Background

• Serum salicylate (aspirin) concentration

Normal Values

• Therapeutic: 15-30 mg/dL
• Toxicity: >30 mg/dL
• Severe toxicity: >60 mg/dL
• Potentially lethal: >90 mg/dL

Interpretation

• Repeat levels every 2 hours until trending down; delayed absorption can occur with enteric-coated preparations or bezoar formation
• Rising levels despite treatment or level >60 mg/dL: consider emergent dialysis
• Classic ABG pattern: early respiratory alkalosis progressing to mixed respiratory alkalosis and metabolic acidosis
• Acidemia increases CNS salicylate penetration and toxicity; avoid intubation if possible (loss of hyperventilation worsens acidosis)
• Urine alkalinization (goal urine pH 7.5-8.0) enhances renal elimination

See Also

• Salicylate toxicity
• Toxicology