There is no antidote for<unk> . Initial treatment of an overdose involves resuscitation measures such as maintaining an adequate airway and adequate circulation followed by gastric decontamination by administering activated charcoal, which adsorbs the<unk>  in the gastrointestinal tract. Stomach pumping is no longer routinely used in the treatment of<unk> s, but is sometimes considered if the patient has ingested a potentially lethal amount less than one hour before presentation. Inducing vomiting with syrup of ipecac is not recommended. Repeated doses of activated charcoal have been proposed to be beneficial in cases of<unk> , especially in ingestion of enteric coated and extended release salicylic acid formulations which are able to remain in the gastrointestinal (GI) tract for longer periods of time. Repeated doses of activated charcoal are also useful to re-adsorb<unk> s in the GI tract that may have desorbed from the previous administration of activated charcoal. The initial dose of activated charcoal is most useful if given within 2 hours of initial ingestion. Contraindications to the use of activated charcoal include altered mental status (due to the risk of aspiration), GI bleeding (often due to<unk> s) or poor gastric motility. Whole bowel irrigation using the laxative polyethylene glycol can be useful to induce the gastrointestinal elimination of<unk> s, particularly if there is partial or diminished response to activated charcoal. Alkalinization of the urine and plasma, by giving a bolus of sodium bicarbonate then adding sodium bicarbonate to maintenance fluids, is an effective method to increase the clearance of<unk> s from the body. Alkalinization of the urine causes<unk> s to be trapped in renal tubules in their ionized form and then readily excreted in the urine. Alkalinization of the urine increases urinary<unk>  excretion by 18 fold. Alkalinization of the plasma decreases the lipid soluble form of<unk> s facilitating movement out of the central nervous system. Oral sodium bicarbonate is contra-indicated in<unk>  toxicity as it can cause dissociation of<unk>  tablets in the GI tract and subsequent increased absorption. Intravenous fluids Intravenous fluids containing dextrose such as dextrose 5% in water (D5W) are recommended to keep a urinary output between 1 and 1.5 millilitres per kilogram per hour. Sodium bicarbonate is given in a significant aspirin overdose<unk>  level greater than 35 mg/dl 6 hours after ingestion) regardless of the serum pH, as it enhances elimination of aspirin in the urine. It is given until a urine pH between 7.5 and 8.0 is achieved. Dialysis Hemodialysis can be used to enhance the removal of<unk>  from the blood, usually in those who are severely poisoned. Examples of severe<unk>  include people with high<unk>  blood levels: 7.25 mmol/l (100 mg/dl) in acute ingestions or 40 mg/dl in chronic ingestions, significant neurotoxicity (agitation, coma, convulsions), kidney failure, pulmonary edema, or cardiovascular instability. Hemodialysis also has the advantage of restoring electrolyte and acid-base abnormalities while removing<unk> . Salicylic acid has a small size (low molecular mass), has a low volume of distribution (is more water soluble), has low tissue binding and is largely free (and not protein bound) at toxic levels in the body; all of which make it easily removable from the body by hemodialysis. Indication for dialysis: #<unk>  level higher than 90 mg/dL # Severe acid base imbalance # Severe cardiac toxicity # Acute respiratory distress syndrome # Cerebral involvement/ neurological signs and symptoms # Rising serum<unk>  level despite alkalinization/multidose activated charcoal, or people in which standard approaches to treatment ave failed # Unable to tolerate fluids with fluid overload
Salicylate poisoning
Sepsis
Tin poisoning
Myocardial infarction
Thallium poisoning
Psychomotor agitation
Sulfuric acid poisoning
Diabetic ketoacidosis