salicylate-induced noncardiogenic pulmonary edema

Q: Salicylate-induced noncardiogenic pulmonary edema is an absolute indication for hemodialysis?

A) True

B) False

Answer: A

Although salicylate-induced noncardiogenic pulmonary edema and acute lung injury (ALI) can occur in acute toxicity, it is more common in older patients, and in cases with chronic ingestion. These patients may present with fever, hyperdynamic shock, and multiple-system organ failure, and popularly called in "pseudo-sepsis."

Hemodialysis is an absolute indication in salicylate-induced noncardiogenic pulmonary edema as volume resuscitation and sodium bicarbonate administration is hard to do, and only way to salvage patient safely from toxicity is hemodialysis. 

#toxicology

References:

1. Niehoff JM, Baltatzis PA. Adult respiratory distress syndrome induced by salicylate toxicity. Postgrad Med 1985; 78:117.

2. 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.

3. Glisson JK, Vesa TS, Bowling MR. Current management of salicylate-induced pulmonary edema. South Med J. 2011 Mar;104(3):225-32. doi: 10.1097/SMJ.0b013e318205e548. PMID: 21297545.