Salsalate Intoxication and Ramifications of Utilizing Nonspecific Analytical Methods in Estimating Quantitative Blood Concentrations

Spontak, S F; Hassan, F M; Spadafora, Michael P.

doi:10.1093/jat/18.4.229

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…Given the similar mechanism of absorption, it is possible that in overdose SSA moves from kinetics similar to non-enteric-coated aspirin and takes on characteristics of enteric-coated aspirin. The one published case of salsalate overdose we found describes a patient with significant presenting clinical symptoms of salicylism, but initial SA concentrations much lower than were expected for the degree of symptomatology [16]. This patient's serum salicylate concentrations ultimately reached 94 mg/dL 8 h after absorption, causing the authors to postulate that the circulating SSA caused similar symptoms to SA prior to hydrolysis [16].…”

Section: Discussionmentioning

confidence: 87%

Delayed Recrudescence to Toxic Salicylate Concentrations After Salsalate Overdose

West

Horowitz

2010

J. Med. Toxicol.

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Salicylates are common exposures. We report an unusual case of salicylate ingestion, as salsalate, with resolution of symptoms and return of salicylate levels to non-toxic values, with a subsequent, unexpected recrudescence to toxic levels requiring reinstitution of therapy. A 31-year-old man ingested unknown amounts of salsalate, hydroxyzine, and a benzodiazepine. He was intubated and treated with IV sodium bicarbonate and two doses of oral activated charcoal. Eight hours after presentation, his serum salicylate concentration peaked at 55 mg/dL, and then decreased to a nadir of 5.6 mg/dL 38 h after presentation, coinciding with return of GI motility. Several hours later salicylate concentrations began to rise, peaking 67 h after presentation at 61.7 mg/dL. He was treated with sodium bicarbonate and charcoal, which resulted in decreased serum salicylate to therapeutic levels. Salicylate ingestions are known to exhibit unusual toxicokinetics and absorption in overdose; however, this is the first case we are aware of that shows a return to toxic concentrations after apparent resolution of toxicity. Recrudescence of salicylate concentrations to a degree that would dictate reinstitution of therapy for overdose is unusual and may warrant prolonged monitoring of serum salicylate concentrations in salsalate ingestions.

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Section: Discussionmentioning

confidence: 87%

Delayed Recrudescence to Toxic Salicylate Concentrations After Salsalate Overdose

West

Horowitz

2010

J. Med. Toxicol.

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“…The longest interval to reported effects after salsalate ingestion was under 45 minutes in an 18-year-old woman (187).…”

Section: Salsalatementioning

confidence: 94%

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

Chyka

Erdman

Christianson

et al. 2007

Clinical Toxicology

113

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected exposure to salicylates by 1) describing the process by which a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key decision elements in managing cases of salicylate exposure, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D).2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C). 4) Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, war...

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Fluorimetric determination of salsalate in urine, serum and pharmaceutical preparations

Pulgarı́n

Bermejo

2000

Talanta

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Salsalate Intoxication and Ramifications of Utilizing Nonspecific Analytical Methods in Estimating Quantitative Blood Concentrations

Cited by 3 publications

References 3 publications

Delayed Recrudescence to Toxic Salicylate Concentrations After Salsalate Overdose

Delayed Recrudescence to Toxic Salicylate Concentrations After Salsalate Overdose

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

Fluorimetric determination of salsalate in urine, serum and pharmaceutical preparations

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