ASA toxicity and HD

Q: Salicylate-induced pulmonary edema is  ____________ indication for hemodialysis? (select one)

A) absolute

B) relative

Answer: A

Salicylate overdose is well known to cause noncardiogenic pulmonary edema and acute lung injury (ALI), particularly in chronic users. 

Salicylate-induced pulmonary edema is an absolute indication of hemodialysis (HD). The mainstay of treatments for salicylate toxicity is sodium bicarbonate and intravenous fluid resuscitation, which can further worsen the pulmonary edema leading to intubation and risk of cardio-pulmonary arrest.

#toxicology

#pulmonary

References:

1. Leatherman JW, Schmitz PG. Fever, hyperdynamic shock, and multiple-system organ failure. A pseudo-sepsis syndrome associated with chronic salicylate intoxication. Chest 1991; 100:1391. 

2. Fertel BS, Nelson LS, Goldfarb DS. The underutilization of hemodialysis in patients with salicylate poisoning. Kidney Int. 2009 Jun;75(12):1349-1353. doi: 10.1038/ki.2008.443. Epub 2008 Aug 20. PMID: 18716600. 

3. Minns AB, Cantrell FL, Clark RF. Death due to acute salicylate intoxication despite dialysis. J Emerg Med. 2011 May;40(5):515-7. doi: 10.1016/j.jemermed.2010.02.015. Epub 2010 Mar 29. PMID: 20347249.