Child accidentally ingest aspirin - Salicylate toxicity

Sometimes child can ingest adult aspirins, It causes Salicylate toxicity, and it is a medical emergency.
Aspirin poisoning can happen among adults also. Because aspirin is widely available over the counter. And it is used for pain management, antipyretic, and anti-thrombotic properties.
Salicylate poisoning causes metabolic disorders. Direct stimulation of the cerebral medulla, causes hyperventilation and respiratory alkalosis.
It increases anaerobic metabolism and lactate level elevated in the blood.
The lactic acid and salicylate metabolites result in metabolic acidosis.
Eventually, the patient fatigues and is no longer able to compensate via hyperventilation, and metabolic acidosis prevails. This results in hemodynamic instability and end-organ damage.
In children different from adults, do not commonly develop mixed metabolic acidosis and respiratory alkalosis.
But an increased anion gap metabolic acidosis is presented.
The liver metabolizes salicylates by first-order elimination, and the inactive metabolites are then excreted in the urine. With increased salicylate levels, these pathways become saturated resulting in zero order elimination.
In an acute salicylate overdose, the onset of symptoms will occur within 3 to 8 hours.
For mild ingestions (salicylate levels 40 to 80 mg/dL) nausea, vomiting, and generalized abdominal pain are common.
Tachypnea is usually present.
Headaches and dizziness may also occur.
The classic finding of tinnitus may also be present.
Patients with moderate salicylate toxicity (80 to 100 mg/dL) will experience more severe neurological symptoms. These can include confusion, slurred speech, and hallucinations. Tachypnea is more pronounced and is accompanied by tachycardia and orthostatic hypotension. Expect these symptoms 6 to 18 hours after ingestion.
During severe toxicity patient can develop seizures, respiratory failure, hypotension, and cardiac dysrhythmias.
Management:
Patients with salicylate toxicity are volume depleted due to hyperventilation, fever, and increased metabolic activity.
Fluid resuscitation should utilize D5 with 3 amps of sodium bicarbonate.
The dextrose will treat the central nervous system (CNS) hypoglycemia.
The sodium bicarb will help correct the metabolic acidosis.
For kids: gastric leverage and add activated charcoal and to produce an alkaline urine increased excretion of the acid.
Patients with minor ingestions and minimal symptoms may be discharged home, if their salicylate levels are down trending and no metabolic derangements are present.
Patients with minor ingestions and minimal symptoms may be discharged home if their salicylate levels are down trending and no metabolic derangements are present.