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November 1, 1965

Salicylate Intoxication

JAMA. 1965;194(5):571. doi:10.1001/jama.1965.03090180095036

To the Editor:—  The subtle nature of salicylate intoxication was well described by Greer et al (193:555, 1965).The implication, however, that at least two of the five cases (1 and 3) manifested metabolic acidosis does not appear warranted. The authors seem to base this conclusion on the finding of hyperventilation in a patient with low plasma carbon dioxide combining power and an elevated serum salicylate level. In case 5, "surprisingly, acidosis was not present."The above-mentioned triad has trapped many clinicians (including this writer) into a mistaken diagnosis of metabolic acidosis, when in reality it is respiratory alkalosis.The time-honored concept of salicylate pathophysiology discussed by the authors, in which (initial) respiratory alkalosis progresses to metabolic acidosis, does not appear as rational as the "mixed disturbance" pathogenetic view of Winters.1 In his opinion, a tripartite action of salicylate simultaneously produces ketosis, stimulation of respiration, and an increase in

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