![]() ![]() The salicylic acid itself contributes very little to the anion gap, even in high doses. The acidaemia then promotes the entry of salicylate into the CNS, and the level of consciousness degenerates into profound coma with seizures. ![]() ![]() The metabolic acidosis is a high anion gap variety, with lactate and ketones being the extra anions. The patient ultimately develops severe metabolic acidosis with multi organ system failure. The mechanism for this is a combination of direct neurotoxicity, neuroglycopenia and cereberal oedema. The ensuing volume depletion may give rise to hypotension. They progress to hosing you with vomit, because of direct irritation of the gastric mucosa as well as irritation of the medullary chemoreceptor regions. One does not need to have tinnitus or hearing loss in order to be suffering from severe toxicity conversely it can be seen even in therapeutic doses. The classical trend is for these people to present with tinnitus, fever and respiratory alkalosis.
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