Disposition

A patient may be discharged following adequate GI decontamination, if there is progressive clinical improvement, no significant acid-base disturbance, and a documented serial decline in serum salicylate levels toward the therapeutic range. If there is any doubt, the patient should be admitted to an appropriate setting.

In the management of salicylism, "knee jerk" responses should be avoided when assessing salicylate level. Therapeutic decisions should not be based solely on the serum salicylate concentration. Although the determination of serial salicylate levels offers valuable information regarding the effectiveness of the treatment implemented, it is a poor substitute for clinical evaluation of a patient. The final decision when considering management options should be individualized according to the clinical condition of the patient and not depend on a particular salicylate level. Early consultation with a clinical toxicologist is prudent.

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