brain glucose with normal plasma glucose in salicylate poisoning

Q: Salicylate overdose causes - select one

A) CNS glucose to go up

B) CNS glucose to go down

Answer: B

Hemodialysis is recommended in salicylate over dosage with a level at or above 100 mg/dL (cut it to half if history suggests chronic ingestion). However, if there is any sign of neurological manifestation, dialysis is indicated despite the normal level.

Salicylate causes "neuroglycopenia" (lower CNS glucose level) despite normal serum glucose. As the patient gets more and more acidotic, salicylate enters the CNS and, by direct effect, causes neuroglycopenia. 7 indications of Hemodialysis in Salicylate poisoning

• Mental status change
• Pulmonary edema
• Cerebral edema
• Associated or with renal failure
• Level at or above 100 mg/dL(half if chronic ingestion)
• If fluid overload prevents alkalinization
• Patient continues to deteriorate clinically

#neurology

#toxicology

References: 

1. Thurston JH, Pollock PG, Warren SK, Jones EM. Reduced brain glucose with normal plasma glucose in salicylate poisoning. J Clin Invest. 1970 Nov;49(11):2139-45. doi: 10.1172/JCI106431. PMID: 4319971; PMCID: PMC535789.

2. An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose -Emerg Med J 2002; 19:206-209

3. American College of Medical Toxicology. Guidance document: management priorities in salicylate toxicity. J Med Toxicol. 2015 Mar;11(1):149-52. doi: 10.1007/s13181-013-0362-3. PMID: 25715929; PMCID: PMC4371029.

4. Palmer BF, Clegg DJ. Salicylate Toxicity. N Engl J Med. 2020 Jun 25;382(26):2544-2555. doi: 10.1056/NEJMra2010852. PMID: 32579814.