Citation

West PL, Horowitz BZ. J. Med. Toxicol. 2010; 6(2): 150-154.

Copyright

(Copyright © 2010, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s13181-010-0070-1

PMID

20405267

PMCID

PMC3550278

Abstract

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.

Language: en

Keywords

Humans; Adult; Male; Drug Overdose; Suicide, Attempted; Antidotes; Benzodiazepines; Recurrence; Hypnotics and Sedatives; Depressive Disorder; Stress Disorders, Post-Traumatic; Charcoal; Anti-Inflammatory Agents, Non-Steroidal; Salicylates; Sodium Bicarbonate; Antacids; Hydroxyzine