What are the key clinical features and symptoms that should raise suspicion of salicylate poisoning in a primary care setting?

Key clinical features and symptoms that should raise suspicion of salicylate poisoning in a primary care setting include:

• Respiratory symptoms: Hyperventilation leading to respiratory alkalosis is an early and common sign, often presenting as rapid, deep breathing and dyspnoea.
• Neurological symptoms: Patients may exhibit tinnitus, dizziness, confusion, agitation, and in severe cases, seizures or coma.
• Gastrointestinal symptoms: Nausea, vomiting, and abdominal pain are frequent initial complaints.
• Metabolic disturbances: Mixed acid-base disturbances are characteristic, with initial respiratory alkalosis followed by metabolic acidosis as toxicity progresses.
• Other signs: Sweating, dehydration, and fever may be present, along with signs of volume depletion.
• History clues: A history of aspirin or salicylate ingestion, either accidental or intentional, especially in children or vulnerable adults, should heighten suspicion.

In primary care, the combination of these symptoms—particularly unexplained hyperventilation with tinnitus and gastrointestinal upset—should prompt consideration of salicylate poisoning and urgent referral for further assessment and management NICE CG89 Krause et al. 1992Reingardiene 2006.