Managing Salicylate Poisoning in Children

Specific therapy for any internal poisoning consists of efforts to detoxify the poisonous substance, to degrade it, or to remove it from the body. Neither of the first two approaches is applicable to the management of salicylate poisoning, for no method has been devised which will reduce the toxicity of the salicyl radical, and, while approximately 20% of the salicyl radical is normally degraded in humans,¹no means of augmenting this process is available. Hence, specific therapy has been directed entirely toward effecting rapid removal of salicylates from the body. Case reports have indicated that this can be accomplished by exchange transfusion²⁻⁸or by dialysis.⁹⁻¹² Since 1931 it has been known that when the urine is alkaline the rate of renal excretion of salicylates is accelerated.¹³One means of rendering the urine alkaline is the intravenous infusion of sodium in the form of either sodium bicarbonate