Treatment of aspirin toxicity includes administration of IV sodium bicarbonate and monitoring urine pH (goal pH, 7.2-7.5). Alkalinization of the urine promotes salicylate excretion. Administration of acetazolamide would alkalinize the patients urine but is not indicated in the treatment of aspirin toxicity. Acetazolamide, a carbonic anhydrase inhibitor, reduces bicarbonate reabsorption and as a result raises urine pH and enhances salicylate excretion. However, this effect lowers arterial pH and promotes salicylate movement into the central nervous system. Although dialysis can be used to treat severe aspirin toxicity, this patient does not have an indication for hemodialysis (eg, altered mental status, renal insufficiency interfering with salicylate excretion, volume overload preventing treatment with sodium bicarbonate, serum salicylate levels > 100 mg/dL, clinical evidence of pulmonary or cerebral edema, deterioration in clinical status despite appropriate aggressive care).
N-acetylcysteine is used in acetaminophen overdose and has no role in the treatment of salicylate toxicity. Forced hyperventilation is not indicated.
- Sodium bicarbonate IV.
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