During a salicylate overdose, what is the treatment of choice along with supportive measures?

In the context of a salicylate overdose, the treatment of choice includes both supportive measures and the use of hemodialysis, particularly in severe cases or when there are significant complications arising from the overdose. Hemodialysis is particularly effective because it rapidly removes salicylate from the bloodstream, especially when levels are life-threatening or when there is impaired renal function, making other treatments less effective.

Salicylates can cause metabolic acidosis and respiratory alkalosis, and hemodialysis not only aids in the elimination of the drug but also helps correct these acid-base disturbances more effectively than other methods. It is especially indicated in patients with severe toxicity defined by high salicylate levels, altered mental status, or other clinical signs of significant toxicity.

While other treatments, such as sodium bicarbonate, are helpful in managing metabolic acidosis and assisting in urinary alkalinization by increasing the excretion of salicylates, they do not achieve the rapid clearance of salicylate that hemodialysis does. Thus, in terms of efficacy in severe cases, hemodialysis is the recommended course of action.