Fatal In Utero Salicylism

Rejent, Thomas A.; Baik, Sung-ook

doi:10.1520/jfs11029j

Cited by 17 publications

(5 citation statements)

References 1 publication

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“…The increased sensitivity of the fetus relative to its mother is demonstrated by our patient and three other intrauterine deaths. 1 " 3 The clinical manifestations and management of salicylate poisoning in the adult are well described elsewhere. 4 Toxic doses of aspirin produce stimulation of the respiratory center of the medulla oblongata, uncoupling of oxidative phosphorylation, and interference with acid-base homeostasis.…”

Section: Discussionmentioning

confidence: 99%

Aspirin Poisoning During Pregnancy: Increased Fetal Sensitivity

Palatnick

Tenenbein

1998

Amer J Perinatol

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Descriptions of salicylate poisoning during pregnancy are rare and unique features of perinatal physiology predict an increased sensitivity of the fetus to aspirin poisoning. A 17-year-old, 37-week pregnant woman presented to the hospital stating that she had ingested 50 aspirin tablets per day for 1 month in an attempt to harm her baby and herself. Ultrasound showed fetal demise. Serum salicylate was 620 mg/L with an anion gap of 22.6 and the following blood gases: pO2 108 mm Hg, pCO2 15mm Hg, pH 7.34, and HCO3 8.8 mmol/L. She was successfully treated with alkaline diuresis followed by hemodialysis. She spontaneously delivered a macerated stillborn 2380-g fetus. Autopsy revealed diffuse petechiae in the lungs, heart, thymus, and kidneys. Salicylic acid was found in the cord blood, but quantification was not possible due to the small volume of the blood sample. Our patient supports the hypothesis that the fetus is at greater risk than the mother in salicylate poisoning during pregnancy. Consideration should be given to emergent delivery of term or near-term, aspirin-poisoned fetuses.

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Section: Discussionmentioning

confidence: 99%

Aspirin Poisoning During Pregnancy: Increased Fetal Sensitivity

Palatnick

Tenenbein

1998

Amer J Perinatol

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“…11,12 For these physiologic reasons, fetal effects of maternal ASA toxicity can also be extremely detrimental, with reports ranging from nonreassuring fetal heart rate tracing requiring emergency cesarean delivery to fetal demise. [13][14][15] The patient's salicylate and APAP concentrations measured shortly after ingestion suggest that she may have consumed a lower dose of toxins than reported. Although the patient's only apparent symptom of acute ASA overdose was a change in hearing, the fetal effects of these ingestions appeared to be much more significant, with fetal tachycardia and decelerations on fetal heart monitoring.…”

Section: Discussionmentioning

confidence: 81%

Toxic Ingestion of Acetaminophen and Acetylsalicylic Acid in a Parturient at 33 Weeks Gestation: A Case Report

Reale¹,

Gray

Boyer

et al. 2019

A&A Practice

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The anesthetic management of toxic ingestion during pregnancy requires concomitant concerns for both mother and fetus. We describe the management of a parturient at 33 weeks of gestation after a suicide attempt by ingestion of acetaminophen (APAP) and acetylsalicylic acid (ASA). Timing of toxin ingestion must be determined, prompt antidote administration prioritized, and hepatotoxicity-induced hematologic impairment anticipated. Fetal exposure to toxins must also be minimized. The use of point-of-care rotational thromboelastometry in conjunction with standard coagulation testing in such cases facilitates consideration of neuraxial anesthesia and determination of risk for postpartum hemorrhage. We report the presentation and delivery of a parturient who ingested toxic levels of APAP and ASA in a suicide attempt. Written consent to use and existing protected health information was obtained.

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“…However, it has been noted that the severity of the intoxication does not always correlate with serum salicylate levels [ 13 ]. While neither our case nor prior cases have met these criteria, the three cases involving fetal demise in utero involved maternal salicylate levels in the 50–60 mg/dL range [ 3 , 4 ], and it has been shown that fetal blood levels are ∼1.5 times maternal levels [ 9 , 11 ]. Furthermore, the neonate eliminates salicylate more slowly due to immature glucuronidation and renal excretory pathways [ 9 , 11 ], and salicylate tends to concentrate in the fetal brain due to a smaller intravascular/intracellular pH gradient in the fetus [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been several prior reports of in utero salicylate toxicity, with three involving acute ingestion [ 1 – 3 ], two of which resulted in intrauterine fetal demise [ 2 , 3 ]. The remaining cases involve chronic daily usage in the last trimester of pregnancy, and in two of such cases [ 4 , 5 ], fetal or neonatal death was the result, one in utero [ 4 ] and one at day of life nine [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

A 19-year-old at 37 weeks gestation with an acute acetylsalicylic acid overdose

Farid

Wojcik

Christopher

2011

Clinical Kidney Journal

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Acute salicylate overdose in pregnancy is potentially fatal for both the mother and fetus and presents a unique challenge in intensive care management. While suggested thresholds exist for hemodialysis in adults with toxic salicylate ingestion, it is unclear if these thresholds remain appropriate for the gravid patient, particularly given that medications such as acetylsalicylic acid may cross the placental barrier and accumulate in the fetal bloodstream. We describe a case of a gravid patient at ∼37 weeks gestational age with a self-reported acetylsalicylic acid ingestion of 32.5 g and review prior cases of both acute and chronic salicylate ingestion in pregnancy in order to determine the clinical precedent for hemodialysis in this situation.

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Fatal In Utero Salicylism

Abstract: An aspirin overdose by an eight-month primigravida proved to be the mechanism of death for the fetus. Clinical progress of the mother and postmortem concentrations of salicylate in the fetus are listed exhibiting the fetal survival time of about 18 to 20 h post ingestion by the mother.

Cited by 17 publications

References 1 publication

Aspirin Poisoning During Pregnancy: Increased Fetal Sensitivity

Aspirin Poisoning During Pregnancy: Increased Fetal Sensitivity

Toxic Ingestion of Acetaminophen and Acetylsalicylic Acid in a Parturient at 33 Weeks Gestation: A Case Report

A 19-year-old at 37 weeks gestation with an acute acetylsalicylic acid overdose

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