Hemodialysis may be required to enhance salicylate elimination in patients with severe neurologic impairment, renal or respiratory insufficiency, acidemia despite other measures, or very high serum salicylate levels (> 100 mg / dL [> 7.25 mmol / L] with acute overdose or > 60 mg / dL [> 4.35 mmol / L] with chronic overdose).