Alkalinization of the urine causes salicylates to be trapped in renal tubules in their ionized form and then readily excreted in the urine. Alkalinization of the urine increases urinary salicylate excretion by 18 fold. Alkalinization of the plasma decreases the lipid soluble form of salicylates facilitating movement out of the central nervous system. Oral sodium bicarbonate is contra-indicated in salicylate toxicity as it can cause dissociation of salicylate tablets in the GI tract and subsequent increased absorption. Intravenous fluids
Intravenous fluids containing dextrose such as dextrose 5% in water (D5W) are recommended to keep a urinary output between 1 and 1.5 millilitres per kilogram per hour.Sodium bicarbonate is given in a significant aspirin overdose (salicylate level greater than 35 mg/dL 6 hours after ingestion) regardless of the serum pH, as it enhances elimination of aspirin in the urine. It is given until a urine pH between 7.5 and 8.0 is achieved. Dialysis
Hemodialysis can be used to enhance the removal of salicylate from the blood, usually in those who are severely poisoned. Examples of severe poisoning include people with high salicylate blood levels: 7.25 mmol/L (100 mg/dL) in acute ingestions or 40 mg/dL in chronic ingestions, significant neurotoxicity (agitation, coma, convulsions), kidney failure, pulmonary edema, or cardiovascular instability.
Hemodialysis also has the advantage of restoring electrolyte and acid-base abnormalities while removing salicylate.Salicylic acid has a small size (low molecular mass), has a low volume of distribution (is more water soluble), has low tissue binding and is largely free (and not protein bound) at toxic levels in the body; all of which make it easily removable from the body by hemodialysis.Indication for dialysis:

Salicylate level higher than 90 mg/dL
Severe acid base imbalance
Severe cardiac toxicity
Acute respiratory distress syndrome
Cerebral involvement/ neurological signs and symptoms
Rising serum salicylate level despite alkalinization/multidose activated charcoal, or people in which standard approaches to treatment ave failed
Unable to tolerate fluids with fluid overload

Epidemiology
Acute salicylate toxicity usually occurs after an intentional ingestion by younger adults, often with a history of psychiatric disease or previous overdose, whereas chronic toxicity usually occurs in older adults who experience inadvertent overdose while ingesting salicylates therapeutically over longer periods of time.During the latter part of the 20th century, the number of  poisonings from salicylates  declined, mainly because of the increased popularity of other over-the-counter analgesics such as paracetamol (acetaminophen). Fifty-two deaths involving single-ingredient aspirin were reported in the United States in 2000; however, in all but three of these cases, the reason for the ingestion of lethal doses was intentional—predominantly suicidal. History
Aspirin poisoning has controversially been cited as a possible cause of the high mortality rate during the 1918 flu pandemic, which killed 50 to 100 million people. See also
NSAID hypersensitivity reactions
Reye syndrome
Salicylate sensitivity

References
External links

Reingardiene, D; Lazauskas, R (2006). "[Acute salicylate poisoning]". Medicina (Kaunas, Lithuania). 42 (1): 79–83.