A review of all fatal cases of salicylate poisoning in Ontario during 1983 and 1984 disclosed that salicylates were the most common agent responsible for single-drug deaths (51 cases in two years). The patients' conditions on arrival at the hospital were variable: 31.4% of the patients were dead on arrival, 21.6% of the patients were comatose, and 45.1% of the patients were alert but symptomatic on arrival. Interestingly, the third group had the highest serum salicylate levels. The patients who were alive on arrival at the hospital died an average of 13 hours later. Autopsy results showed that 50% of patients had pulmonary abnormalities, 28% had lesions of the gastrointestinal tract, and 18% had nervous system abnormalities; 25.6% of patients on whom autopsies had been performed had no acute pathologic changes. Management difficulties occurred in establishing the diagnosis, administering activated charcoal, and using hemodialysis. Suggestions are offered for the improvement of the care provided to patients with severe salicylate poisoning.