Pulmonary edema in ASA overdose

Q: The best approach to treat pulmonary edema induced due to salicylate toxicity is? (select one) 

A) aggressive volume resuscitation 

B) sodium bicarbonate 

C) emergent hemodialysis 

D) acidification of urine

E) activated charcoal

Answer: C

Non-cardiogenic pulmonary edema in salicylate toxicity requires emergent hemodialysis. In fact, this is considered an absolute indication of emergent hemodialysis. All other options tend to worsen the pulmonary edema including intravenous fluid resuscitation (choice A) and sodium bicarbonate (choice B). Salicylate poisoning requires alkalinization of urine, not acidification (choice D). Activated charcoal is helpful in the initial stages of poisoning for gastric decontamination but plays no role in relieving pulmonary edema (choice E).

#toxicology

References:

1. Heffner JE, Sahn SA. Salicylate-induced pulmonary edema. Clinical features and prognosis. Ann Intern Med 1981; 95:405. 

2. Glisson JK, Vesa TS, Bowling MR. Current management of salicylate-induced pulmonary edema. South Med J 2011; 104:225. 

3. Papacostas MF, Hoge M, Baum M, Davila SZ. Use of continuous renal replacement therapy in salicylate toxicity: A case report and review of the literature. Heart Lung 2016; 45:460.