Prognosis

Salicylate levels as a predictor of outcome

Serum salicylate levels >80 mg/dL (>5.8 mmol/L) in adults and >70 mg/dL (>5.1 mmol/L) in children or older people indicate severe poisoning and increased likelihood of fatal ingestion.[18] Patients with chronic salicylism and levels 40 to 60 mg/dL (2.9 to 4.3 mmol/L) can be severely ill and at risk of death. Nonfatal salicylate poisoning is associated with a full recovery.[18]

It is important to note that substantial clinical signs and symptoms, particularly neurologic signs and noncardiogenic pulmonary edema, can be present with lower levels of salicylate, particularly in cases of chronic ingestions. Therefore, salicylate level alone is not a reliable predictor of outcome.[32]

Time from ingestion to treatment

Risk of death and serious toxicity from acute ingestion increases with increasing interval between ingestion and treatment. One study showed that substantial morbidity and mortality increased if the estimated interval between ingestion of large amounts of salicylate and treatment exceeded 12 hours.[33] Unfortunately, accurate reporting of timing of poisoning and estimation of dose is highly variable in the literature.[2]

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