What is Salicylates Toxicity?
Salicylate toxicity, which is an urgent medical matter, happens when too much salicylate – a common ingredient in many medicines – is consumed. This can be either on purpose or accidental. Too much salicylate can cause serious changes in your body’s usual functioning, which makes it harder for doctors to treat the condition. If other medicines were taken at the same time, it could make the situation more complex and challenging to manage.
What Causes Salicylates Toxicity?
Salicylates are commonly used medications that can be bought without a prescription. They’re often used for pain relief, reducing fever, and preventing blood clots. However, if someone takes too much at once, or takes them regularly over a long period, it can lead to a condition known as salicylate toxicity. This happens when there’s too much of the drug in the body.
They can also be found combined with other types of medications like painkillers, antihistamines (which treat allergies), and anticholinergics (which are used to treat various conditions like asthma and dizziness). This can make it harder for doctors to treat if salicylate toxicity occurs, as they need to consider the effects of these other medications too.
Risk Factors and Frequency for Salicylates Toxicity
In 2011, around 30,000 cases of salicylate toxicity, a type of poisoning, were reported in the United States, leading to 39 deaths. Although the death rate was less than 0.01%, this number rose to 15% for those who were severely poisoned. The problems heightened if the condition was not identified immediately.
Signs and Symptoms of Salicylates Toxicity
When someone has swallowed a harmful substance, the situation calls for several precise details. It’s necessary to learn when the person swallowed it, how much was ingested, and what kind of substance it was, as this can affect how quickly the body absorbs it. Another key piece of information is whether the person consumed any other substances alongside it. This could make the treatment more complex and increase the risk of serious complications. It’s also vital to find out whether the person swallowed the substance by accident or on purpose. Friends, family, or emergency medical staff can often verify this information.
Taking too many salicylates – a type of drug found in various medicines – can lead to an overdose. Symptoms typically appear between 3 to 8 hours after ingestion. The severity of these symptoms depends on how much was swallowed.
- For less severe cases (salicylate levels 40 to 80 mg/dL), common symptoms include nausea, vomiting, overall stomach pain, rapid breathing, headaches, dizziness, and possibly ringing in the ears. However, this can also happen at non-toxic levels.
- If toxicity becomes moderate (80 to 100 mg/dL), symptoms can escalate to confusion, slurred speech, hallucinations, rapid heart rate, low blood pressure when standing up, and these symptoms generally appear between 6 to 18 hours after ingestion.
- In severe cases (salicylate levels over 100 mg/dL), symptoms typically appear 12 to 24 hours after ingestion. These include swelling in the brain and lungs, drowsiness, seizures, shallow breathing, low blood pressure caused by acid buildup and loss of body fluids, and irregular heart rhythms. The most common of these is an abnormally fast heartbeat, but the person could also suffer a cardiac arrest with the most typical rhythm being an absence of electrical activity in the heart (asystole).
Chronic salicylate toxicity, where the person has consumed too many salicylates over an extended period, can result in similar symptoms at lower levels. In children, symptoms may worsen more quickly than in adults.
Testing for Salicylates Toxicity
If your doctor suspects you may have been exposed to too much salicylate, a type of drug often found in medications like aspirin, they will likely order a test to measure the amount of salicylate in your body. Since the speed at which the drug is absorbed into your body can vary, they may need to repeat this test over time to track any changes. Along with this, they may also measure the level of acetaminophen, another common painkiller, as sometimes patients can be unsure about exactly what they’ve taken.
Your doctor will also likely order other tests to ensure that all bases are covered. These tests include checking your body’s levels of electrolytes, which are minerals essential for body functions, levels of calcium and magnesium, and checking for any abnormalities in your body’s acid-base balance. Other tests your doctor might recommend include: liver function tests (LFTs), complete blood count (CBC), lactate, coagulation studies to assess your blood’s ability to clot, and an electrocardiogram (ECG) to check if your heart rhythm is normal. If you’re confused or having trouble thinking clearly, they might also recommend a CT scan, a type of X-ray that gives detailed pictures of your brain.
If you’ve been exposed to small amounts of salicylate, your initial test results might look normal or only slightly abnormal. You might be breathing faster than normal, which can cause changes in your blood’s acid-base balance. As the level of salicylate in your body increases, you might start to develop metabolic acidosis, a condition that occurs when your body produces too much acid or your kidneys aren’t removing enough acid from your body. Metabolic acidosis can cause rapid breathing, confusion, and extreme tiredness. Other possible effects of salicylate exposure include a decreased blood platelet count, low potassium levels, high calcium levels, and increased levels of substances that your kidneys normally remove, such as BUN, creatinine, and lactate. If the salicylate exposure is severe, your metabolic acidosis may get worse.
Treatment Options for Salicylates Toxicity
Patients suffering from salicylate toxicity, which could be caused by consuming too much medication containing salicylate like aspirin, often have symptoms like rapid breathing, fever, and higher than normal body activities. Because of this, they may have less body fluid than is healthy. To treat this, they should be given fluids for rehydration. The fluids given should contain dextrose and sodium bicarbonate. Dextrose helps to deal with low blood sugar affecting the brain whereas sodium bicarbonate helps correct the imbalance in body acids and bases known as metabolic acidosis. If the patient’s potassium levels are too low, they should also receive potassium supplements. The goal is to keep the urine output at around 2 to 3 milliliters per kilogram of the patient’s body weight each hour.
In severe cases of salicylate toxicity, patients may become too tired to keep up with their body’s need for larger amounts of air. In this case, they may need to be put on a ventilator to help them breathe. Sodium bicarbonate can also help to manage their body’s pH, which is a measure of the body’s level of acids and bases. After the patient is put on the ventilator, they should receive kidney dialysis urgently because the ventilator will be less effective in managing the imbalance in the body’s acids and bases. Fluid treatment may cause swelling in the lungs, leading to breathing difficulties.
The next step after initial stabilization is to lower the levels of salicylate in the patient’s blood. Methods for this include using activated charcoal, which decreases salicylate levels. However, it doesn’t show clear benefits on disease outcome or patients’ survival. Pumping the stomach might help if the patient had recently consumed aspirin that has an enteric coating. If the patient is at high risk for food or liquid entering the windpipe, these methods should be avoided. Using a method called whole bowel irrigation doesn’t help and may actually increase absorption of the salicylate consumed.
In addition to hydration, making the patient’s blood more alkalinic, which means it contains more base than acid, will help the body get rid of the excess salicylate. Dialysis can also help with this and might be necessary if the patient has severe symptoms like low blood pressure or high levels of acidity in the body despite fluid treatment, high salicylate blood levels, the need for a ventilator, or severe organ damage. Severe organ damage symptoms may include seizures, a condition resulting in the death of muscle tissue called rhabdomyolysis, swelling in the lungs or brain, and kidney failure. Dialysis helps remove salicylates and lactate, which is a byproduct of metabolism increased in acidosis, from the body, which should help in managing the body’s level of acids and bases.
If the patient has seizures, they should be given benzodiazepines. They should also be given glucose to deal with possible low blood sugar levels in the patient’s brain. After a seizure, the patient’s body will be more acidic, and applying a sodium bicarbonate bolus may be considered to cope with the acidity.
Patients who have consumed a small amount of salicylate and have minimal symptoms, after observation and treatment, can be allowed to return home if their salicylate levels have gone down and there is no imbalance in the body’s acids and bases. Patients whose condition is deteriorating should be sent to the intensive care unit for further observation and treatment.
What else can Salicylates Toxicity be?
Here are some potential reasons for a person’s symptoms:
- Caffeine toxicity (consuming too much caffeine)
- Ethylene glycol overdose (an excess intake of a chemical often found in antifreeze and other industrial products)
- Hydrocarbon toxicity (exposure to harmful chemicals that exist in many forms)
- Sepsis (a life-threatening condition caused by the body’s response to an infection)
- Drug withdrawal symptoms (symptoms that can occur after stopping or reducing intake of a drug)
- Iron toxicity (consuming too much iron)
- Schizophrenia (a serious mental disorder that affects thinking, feelings, and behavior)
Possible Complications When Diagnosed with Salicylates Toxicity
- Respiratory Arrest – This means the patient stops breathing entirely.
- Apnea – This is when there are pauses in breathing, which can often occur during sleep.
- Dyspnea – This is a term for difficulty or discomfort when breathing, usually described as shortness of breath.
- Aspiration Pneumonitis – This happens when food, stomach acid, or saliva is accidentally inhaled into the lungs, leading to inflammation or infection.
- Deafness – This means a loss of the ability to hear.
- Tinnitus – This is a symptom characterized by hearing constant ringing, buzzing or other noises in the ears.
- Asystole – This is a term for cardiac arrest or, more simply put, when the heart stops beating.
- Hypotension – This is when blood pressure becomes too low.
- Encephalopathy – This term refers to any condition that causes changes in brain function or structure.
- Seizures – These are sudden, uncontrolled electrical disturbances in the brain that may cause problems with muscle control, behavior, sensation and/or consciousness.
- Coma – This is a prolonged state of unconsciousness.
