Case history
Case history #1
A 17-year-old boy is brought to the hospital by the police due to an overdose of unknown drugs after a fight with his girlfriend. Initial physical exam is unremarkable except for a BP of 149/99 mmHg and sinus tachycardia at a rate of 130 bpm. However, shortly after arrival in the emergency department, the patient developed convulsions and required intubation. Serum electrolyte panel and ABG analysis reveals a wide anion-gap metabolic acidosis. Screen for drugs of abuse and alcohol is negative. The patient is found to have a serum salicylate level of 94.8 mg/dL.
Case history #2
A 68-year-old woman presents to the emergency department with vague complaints of feeling ill over the past several days. She reports generalized body pains and consequently has taken a nonprescription analgesic that contains aspirin, as well as acetaminophen, diphenhydramine, and several other cold preparations over the past 72 hours. Since the night before presentation she appeared confused and provided vague responses to questions. In addition, she cannot understand that she has been ingesting multiple medications that included the same chemical. On physical exam, she is noted to have tachypnea. Laboratory investigations reveal a serum bicarbonate level of 9 mmol/L and a salicylate level of 50.6 mg/dL.
Other presentations
Although uncommon, fatal salicylate poisoning from topical application of joint liniments containing methyl salicylate has been known to occur. The presence of contact dermatitis may be a vital clue in such cases.
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