A reassessment of the treatment of salicylate poisoning.

The treatment of salicylate poisoning is based on the prevention of further absorption, and enhancement of excretion of already absorbed drug. A variety of methods based on this rationale have been used over the years. One of the more popular and successful treatments has been forced alkaline diuresis to encourage excretion. This technique, however, is not without risk and has now been replaced with alkalinisation alone, which has been shown to be safer and equally successful. The use of activated charcoal as an acute absorbing agent for drug still in the upper gastrointestinal tract is beneficial in minimising further absorption. A recent development in the use of activated charcoal is the administration of multiple doses which are believed to enhance elimination of absorbed drug. The charcoal adsorbs salicylate diffusing back into the gut from the coeliac and mesenteric blood vessels thereby effectively eliminating it--a form of 'internal peritoneal dialysis'. Multiple-dose activated charcoal and alkalinisation are currently the most popular methods of treatment.