Toxicity of salicylates.

Salicylate intoxication remains a common problem in Britain; about 10 percent of adult hospital admissions for deliberate self-poisoning involve these drugs. Accidental salicylate poisoning in children has been considerably reduced since the introduction of child-resistant containers. In the United Kingdom, the annual number of salicylate-related deaths has fallen slightly between 1967 and 1980. Diagnosis of salicylate intoxication is made from patient history, circumstantial evidence, and common clinical features (tinnitus, deafness, sweating, hyperventilation), and is confirmed by measurement of the plasma salicylate concentration. Gastric emptying by lavage or emesis is an important part of the management of acute overdose. About 20 percent of adults require forced alkaline diuresis to enhance elimination of salicylate from the body. Hemodialysis and hemoperfusion are seldom indicated. The mortality rate from acute salicylate poisoning in hospital-treated adults is about one percent; death is usually preceded by neurologic features and a dominant metabolic acidosis. Chronic salicylate intoxication may follow the administration of oral therapeutic doses or the use of ointments containing acetylsalicylic acid since metabolic pathways (mainly conjugation with glycine and glucuronic acid) are readily saturated. The incidence of chronic therapeutic intoxication is unknown but appears low and is usually encountered in young children and the elderly. Diagnosis is frequently delayed because of a low index of suspicion, which in turn delays treatment and increases morbidity and mortality rates.