When should a patient with salicylate poisoning be urgently referred to secondary care or an emergency department?

Patients with salicylate poisoning should be urgently referred to secondary care or an emergency department if they present with signs of severe toxicity, such as altered mental state, respiratory distress, or metabolic disturbances. This includes symptoms like confusion, agitation, hyperventilation, or evidence of acid-base imbalance. Urgent referral is also indicated if there is a history of a large overdose or if the patient’s clinical condition is deteriorating rapidly. Immediate hospital assessment is necessary to perform blood salicylate levels, monitor vital signs, and initiate appropriate treatment such as activated charcoal administration, intravenous fluids, and correction of acid-base and electrolyte imbalances. Any patient suspected of salicylate poisoning with significant symptoms or risk factors should be transferred promptly to an emergency department for specialist care.