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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Acute salicylate intoxication is one of the most common causes of intoxication from antipyretics&#46; In fact&#44; in recent years&#44; the incidence of this condition has decreased due to a greater use of other drugs&#44; such as paracetamol and non-steroid anti-inflammatory drugs&#46;</p><p class="elsevierStylePara">Here we present the case report of a 60-year old woman with a background of depression that sought emergency treatment for mild cognitive impairment and consumption of multiple acetylsalicylic acid tablets&#46; A physical examination revealed sustained arterial hypotension with a systolic blood pressure &#40;SBP&#41; of 80-90mm Hg and diastolic blood pressure &#40;DBP&#41; of 50-60mm Hg&#46; Laboratory tests revealed urea&#58; 81mg&#47;dl&#44; serum creatinine&#58; 1&#46;84mg&#47;dl&#44; pH&#58; 7&#46;39&#44; HCO<span class="elsevierStyleInf">3</span>&#58; 13&#46;9mmol&#47;l&#44; and lactate&#58; 1mmol&#47;l&#46; Serum salicylate levels were positive with concentrations of 65&#46;68mg&#47;dl&#46; We performed a gastric lavage and started abundant hydration treatment and urine alkalization&#44; as well as admitting the patient into the intensive care unit &#40;ICU&#41;&#44; where her low blood pressure values and oliguria continued&#44; and her level of cognitive impairment increased&#46;</p><p class="elsevierStylePara">Given the poor clinical evolution&#44; with increased nitrogen retention values and altered haemodynamics&#44; we decided to provide conventional haemodialysis for four hours&#44; with positive balances &#40;&#43;2500ml&#41; and high-flux polysulfone&#46; The acid-base alterations were corrected following treatment&#44; and drug concentrations decreased to 31&#46;99mg&#47;dl &#40;51&#37; reduction&#41;&#44; with improved cognitive state and normalised blood pressure&#46; The patient was discharged with no organ damage&#46;</p><p class="elsevierStylePara">Therapeutic levels of salicylic acid range between 10mg&#47;dl and 30mg&#47;dl&#44; and higher levels can produce moderate-severe intoxications&#44; causing neurological deficits&#44; coma&#44; convulsions&#44; pulmonary oedema&#44; sustained hypotension&#44; acute renal failure&#44; and severe electrolyte imbalances&#44;<span class="elsevierStyleSup">1</span> although patient death is rare&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Done normograms&#44; which are widely used in several different types of intoxications&#44; should not be used in acute salicylate intoxications because of the poor correlation between serum concentrations and the clinical and&#47;or laboratory alterations produced&#46; Any patient with high salicylate levels should be started on general support measures&#46; A gastric lavage should also be applied in order to reduce the absorption of the toxin and the urine should be alkalised for increased excretion&#44; at the same time as correcting the hydration state and controlling the hydroelectrolytic imbalances&#46; The indications for starting haemodialysis for removing the salicylic acid vary according to author&#44; but the majority coincide that at concentrations greater than 100mg&#47;dl&#44; this treatment is warranted&#44; although others reduce this value to 80mg&#47;dl&#46; In any case&#44; clinical and laboratory alterations will indicate the need for haemodialysis in the majority of cases&#46; In this manner&#44; patients with haemodynamic alterations&#44; acute renal failure&#44; severe neurological alterations&#44; and&#47;or severe metabolic acidosis that do not respond to conservative treatment should be started on extra-corporeal depuration treatment&#46;</p><p class="elsevierStylePara">There is currently no consensus regarding the type of dialysis that should be administered&#46; Warthall&#44; et al<span class="elsevierStyleSup">3</span> described reduced salicylate concentrations by 77&#37; to 84&#37; using continuous veno-venous haemodiafiltration for a mean 11 hours&#44; whereas Lund&#44; et al<span class="elsevierStyleSup">4</span> described similar results using conventional haemodialysis followed by continuous dialysis for 12 hours&#46; In our case&#44; we achieved a 51&#37; reduction using conventional haemodialysis for four hours&#44; which demonstrates the usefulness of this technique in the acute phase&#46; We believe that more studies would be appropriate on this subject&#44; although the results currently available seem to indicate starting treatment with conventional haemodialysis in severe cases or patients with important clinical&#47;laboratory repercussions&#44; since we can achieve a significant reduction in toxin levels within a short period of time&#44; and afterwards the patient can be evaluated for continued depuration treatment with continuous techniques&#44; according to the serum concentrations of salicylates and the previously mentioned alterations&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p>"
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