A review of pathology, corrective measures, and incidence of salicylate poisoning is presented.
A composite patient case (developed to illustrate symptomatology of salicylism) demonstrates a wide range of signs and symptoms. Subsequent discussion of supportive and corrective measures emphasizes correction of the acid-base, and fluid and electrolyte imbalance associated with salicylate poisoning. Treatment is considered within the context of both moderate and severe poisoning; recently developed and traditional procedures are reviewed.
Get full access to this article
View all access options for this article.
References
1.
Tabulation of 1969 Reports: Natl. Clgh. Poison Control Cent. Bull, pp 1–7 (Sept.-Oct.) 1970.
2.
StewartR. B.CluffL. E.: Studies on the Epidemiology of Adverse Drug Reactions VI: Utilization and Interactions of Prescription and Non-Prescription Drugs in Out-patients, The Johns Hopkins Med. J.129: 319–331 (Dec.) 1971.
3.
CaranososG. J.StewartR. B.CluffL. E.: Drug Induced Illness Leading to Hospitalization, J. Am. Med. Assoc.228: 713–717 (May) 1974.
4.
Tabulations of 1972 Reports: Natl. Clgh. Poison Control Cent. Bull. p. 3 (May-June) 1973.
5.
Tabulations of 1972 Reports: Natl. Clgh. Poison Control Cent. Bull. p. 2 (May-June) 1973.
6.
DoneA. K.TempleA. R.: Treatment of Salicylate Poisoning, Modern Treatment8: 528–551 (Aug.) 1971.
7.
PaulB. N.: Salicylate Poisoning in the Elderly: Diagnostic Pitfalls, J. Am. Geriatrics Soc.20: 387–390 (Aug.) 1972.
8.
FergusonR. K.BoutrosA. M.: Death Following Self-Poisoning with Aspirin, J. Am. Med. Assoc.213: 1186–1188 (Aug.) 1970.
JacobzinerH.RaybinH. W.: Briefs on Accidental Chemical Poisoning in New York City, N.Y. State J. Med.61: 301–303 (Jan.) 1961.
11.
WinekC. L.CollomW. D.VoldengN. A.: Label Similarity as an Indirect Cause of a Methyl Salicylate Death, Clin. Toxicol.6: 189–192 (Summer) 1973.
12.
TenneyS. M.MillerR. M.: The Respiratory and Circulatory Actions of Salicylate, Am. J. Med., 19: 498–508 (Oct.) 1955.
13.
BremJ.: Salicylism, Hyperventilation, and the Central Nervous System, J. Pediatr.83: 264–266 (Aug.) 1973.
14.
SmithM. J. H.: Toxicology, In SmithM. J. H.SmithP. K. (eds.), The Salicylates—A Critical Bibliographic Review, Interscience, New York, N.Y., 10012, 1966, pp. 233–306.
15.
SmithM. J. H.: Metabolic Effects of Salicylates, In SmithM. J. H.SmithP. D. (eds.), The Salicylates— A Critical Bibliographic Review, Interscience, New York, N.Y., 10012, 1966 pp. 49–105.
16.
HrnicekG.SkeltonJ.MillerW. C.: Pulmonary Edema and Salicylate Intoxication, J. Am. Med. Assoc.230: 866–867 (Nov.) 1974.
17.
WintersR. W.: Acid-base Disturbances, and the Treatment of Salicylate Intoxication, In St. J. DixonA.MartinB. K.SmithM. J. H.WoodP. H. N. (eds.), Salicylates—An International Symposium, Little Brown and Co., Boston, Mass., 02167, 1963, pp. 270–280.
18.
SegarW. E.HollidayM. A.: Physiologic Abnormalities of Salicylate Intoxication, N. Engl. J. Med.259: 1191–1197 (Dec.) 1958.
NelsonC. J.: A Guide to Glucose Urine Testing Systems for the Pharmacist Teaching the Diabetic Patient, Drug Intell. Clin. Pharm.8: 422–429 (July) 1974.
21.
ThursonJ. H.: Reduced Brain Glucose with Normal Plasma Glucose in Salicylate Poisoning, J. Clin. Invest., 49: 2139–2145 (Nov.) 1970.
22.
HillJ. B.: Current Concepts—Salicylate Intoxication, N. Engl. J. Med., 288: 1110–1113 (May) 1973.
23.
BuchananN.RubinowitzM. B.: Infantile Salicylism—A Reappraisal, J. Pediatr.84: 391–395 (Mar.) 1974.
24.
MillsJ. A.: Drug Therapy—Nonsteroidal Anti-inflammatory Drugs, N. Engl. J. Med.290: 781–784 (Apr.) 1974.
25.
HoltK. S.: Salicylates in Rheumatic Fever, Difficulties Experienced in Treating Children with Large Doses, Lancet2: 1197–1199 (Dec.) 1954.
26.
HillJ. B.: Experimental Salicylate Poisoning: Observations on the Effects of Altering Blood pH on Tissue and Plasma Salicylate Concentrations, Pediatrics47: 658–665 (Apr.) 1971.
ProudfootA. T.BrownS. S.: Acidaemia and Salicylate Poisoning in Adults, Brit. Med. J.2: 547–550 (May) 1996.
29.
WoodburyD. M., Analgesic-Antipyretics, Anti-Inflammatory Agents, and Inhibitors of Uric Acid Synthesis, In GoodmanL. S.GilmanA. (eds.), The Pharmacological Basis of Therapeutics, 4th ed., The MacMillan Company, New York, N.Y., 10012, 1970 p. 320.
30.
QuickA. J.ClesceriL.: Influence of Acetylsalicylic Acid and Salicylamide on the Coagulation of Blood, J. Pharmacol. Exper. Ther.128: 95–98 (Jan.) 1960.
31.
FricP. G.: Hemorrhagic Diathesis with Increased Capillary Fragility by Salicylate Therapy, Am. J. Med. Sci.231: 402–406 (Apr.) 1956.
32.
RappaportA. E.NixonC. E.BakerW. A.: Fatal Secondary Toxic Thrombocytopenic Purpura Due to Sodium Salicylate, Report of a Case, J. Lab. Clin. Med.30: 916–927 (Nov.) 1945.
33.
EvansG.: The Effect of Acetylsalicylic Acid on Platelet Function, J. Exp. Med.128: 877–894 (Nov.) 1968.
34.
MudgeG. H.FoulksJ.GilmanA.: Renal Secretion of Potassium in the Dog During Cellular Dehydration, Am. J. Physiol.161: 159–166 (Apr.) 1950.
35.
RobinE. D.DavidR. P.ReesS. B.: Salicylate Intoxication with Special Reference to the Development of Hypokalemia, Am. J. Med.26: 869–882 (June) 1959.
36.
DoneA. K.: Salicylate Intoxication, Significance of Measurements of Salicylate in Blood in Cases of Acute Ingestion, Pediatrics26: 800–807 (Nov.) 1960.
37.
LevyG.: Pharmacokinetics of Salicylate Elimination in Man, J. Pharm. Sci.54: 959–967 (July) 1965.
38.
LevyG.TsuchiyaT.AmselL. P.: Limited Capacity for Salicyl Phenolic Glucuronide Formation and its Effects on the Kinetics of Salicylate Elimination in Man, Clin. Pharmacol. Ther.13: 258–268 (Mar.-Apr.) 1972.
39.
TsuchiyaT.LevyG.: Biotransformation of Salicylic Acid to the Acyl and Phenolic Glucuronides in Man, J. Pharm. Sci.61: 800–801 (May) 1972.
40.
LevyG.TsuchiyaT.: Salicylate Accumulation Kinetics in Man, N. Engl. J. Med.287: 430–432 (Aug.) 1972.
41.
LevyG.LeonardsJ.: Urine pH and Salicylate Therapy, J. Am. Med. Assoc.217: 81 (July) 1971.
DeckerW. J.CorbyD. G.: Activated Charcoal as a Gastrointestinal Decontaminant: Experiences with Experimental Animals and Human Subjects, Clin. Toxicol.3: 1–4 (Mar.) 1970.
52.
LocketS.: The Treatment of Poisoning: What Do I Do First? (Part II), The Practitioner210: 575–579 (Apr.) 1973.
53.
ChinL.: Induced Emesis—A Questionable Procedure for the Treatment of Acute Poisoning, Am. J. Hosp. Phar.29: 877–879 (Oct.) 1972.
LevyG.TsuchyiaT.: Effect of Activated Charcoal on Aspirin Absorption in Man, Part I, Clin. Pharmacol. Ther.13: 317–322 (May-June) 1973.
56.
DeckerW. J.: Inhibition of Aspirin Absorption by Activated Charcoal and Apomorphine, Clin. Pharmacol. Ther.10: 710–713 (Sept.-Oct.) 1969.
57.
LocketS.: Evaluation of Various Forms of Treatment Administered in Poisoning, The Practitioner210: 709–714 (May) 1973.
58.
GrimmingerP.: Biological Activity of the Various Vitamin K Forms, Vitamins Hormones24: 605–618, 1966.
59.
Phytonadione Monograph, 1961: American Hospital Formulary Service, ReillyM. J. (ed.) American Society of Hospital Pharmacists, Washington, D.C. 20014, 1974, 88: 24.
60.
WintersR. W.: Maintenance Fluid Therapy, In WintersR. W. (ed.), The Body Fluids in Pediatrics, Little Brown and Co., Boston, Mass. 02167, 1973, pp. 113–133.
61.
DellR. B.: Pathophysiology of Dehydration, In WintersR. W. (ed.), The Body Fluids in Pediatrics, Little Brown and Co., Boston, Mass., 02167 1973, pp. 134–154.
62.
WintersR. W.: Salicylate Intoxication, In WintersR. W. (ed.), The Body Fluids in Pediatrics, Little Brown and Co., Boston, Mass., 02167, 1973, pp. 483–497.
63.
Sodium Bicarbonate Monograph, 1959: American Hospital-Formulary Service, ReillyM. J. (ed.), American Society of Hospital Pharmacists, Washington, D.C., 20014, 1974, 40:08.
64.
FileyG. F.: Blood Gas Interactions and Acid-Base Disturbances, In Acid-Base and Blood Gas Regulation, Lea and Febiger, Philadelphia, Pa. 19106, 1971, pp. 111–133.
65.
Tromethamine Monograph, 1970: American Hospitc Formulary Service, ReillyM. J. (ed.), American Society of Hospital Pharmacists, Washington, D.C., 20014, 1974, 40:08.
66.
WintersR. W.: Disorders of Electrolyte and Acid-Base Metabolism, In BarnettH. L.EinhornA. H., (eds.), Pediatrics, Appleton-Century-Crofts, New York, N.Y. 10016, 1968, pp. 336–368.
67.
SmithP. K.: Studies on the Pharmacology of Salicylates, J. Pharmacol.87: 237–255 (July) 1946.
68.
ReimoldE. W.WorthenH. G.ReillyT. P.: Salicylate Poisoning, Comparison of Acetazolamide Administration and Alkaline Diuresis in the Treatment of Experimental Salicylate Intoxication in Puppies, Am. J. Dis. Child.125: 668–674 (May) 1973.
69.
KaplanS. A.del CarmenF. T.: Experimental Salicylate Poisoning: Observations on the Effects on Carbonic Anhydrase Inhibitor and Bicarbonate, Pediatrics21: 762–770 (May) 1958.
70.
SchwartzR.: The Renal Response to Administration of Acetazolamide During Salicylate Intoxication, Pediatrics23: 1103–1114 (June) 1959.
71.
Acetazolamide Monograph, 1959: American Hospital Formulary Service, ReillyM. J. (ed.), American Society of Hospital Pharmacists, Washington, D. C. 20014, 1974, 40:28.
72.
FeuersteinR. C.FinbergL.FleishmanE.: The Use of Acetazolamide in the Therapy of Salicylate Poisoning, Pediatrics25: 215–227 (Feb.) 1960.
73.
RentschJ. B.MarshS. B.: Two Cases of Salicylate Intoxication Successfully Treated by Exchange Transfusion, Am. J. Dis. Child.98: 778–785 (Dec.) 1959.
74.
DoneA. K.OtternessL. J.: Exchange Transfusion in the Treatment of Oil of Wintergreen (Methyl Salicylate) Poisoning, Pediatrics18: 80–85 (July) 1956.
75.
SchlegelR. J.: Peritoneal Dialysis for Severe Salicylism: An Evaluation of Indications and Results, J. Pediat.69: 553–562 (Oct.) 1966.
76.
AndersonJ. A.LeeH. A.StroudC. E.: Haemodialysis in Infants and Small Children, Brit. Med. J.1: 1405–1408 (May) 1965.
77.
RosenbaumJ. L.: The Use of Resin Hemoperfusion in the Treatment of Acute Drug Intoxication, Clin Toxicol.5: 331–335 (Fall) 1972.
78.
Carroll Chemical Co., Mfr. Catalog, Smyrna, Tenn. (Jan.) 1974, p. 4.
79.
Analgesic, Antipyretic, Antirheumatics, Facts and Comparisons, KastrupE. K. (ed.), Facts and Comparisons, Inc., St. Louis, Mo., 63137, 1975, pp. 244–245.
80.
DoneA. K.: Evaluations of Safety Packaging for the Protection of Children, Pediatrics48: 613–628 (Oct.) 1971.
81.
ScherzR. G.: Prevention of Childhood Aspirin Poisoning—Clinical Trials with Three Child-Resistant Containers, N. Engl. J. Med.285: 1361–1362 (Dec.) 1971.
82.
WoodR.: The Quest for a Really Child-Safe Closure System, Mfg. Chem. & Aerosol News44: 22–25 (July) 1973.
