Case history
Case history #1
A 17-year-old boy is brought to the accident and emergency department by the police after an overdose of unknown drugs following a fight with his girlfriend. Initial physical examination is unremarkable except for a blood pressure of 149/99 mmHg and sinus tachycardia of 130 beats per minute. Shortly after arrival, the patient develops convulsions and requires intubation. Serum electrolyte panel and arterial blood gas analysis reveal a wide anion-gap metabolic acidosis. The patient has a serum salicylate level of 948 mg/L (6.9 mmol/L).
Case history #2
A 68-year-old woman presents to the accident and emergency department with vague complaints of feeling unwell over the past several days. She reports generalised body pains and consequently has taken paracetamol, diphenhydramine, and several other cold preparations over the past 72 hours. Her partner reports that since the previous night she has been confused and was providing vague responses to questions. On examination, she is confused. She has tachypnoea. Laboratory investigations reveal a serum bicarbonate level of 9 mmol/L and a salicylate level of 506 mg/L (3.7 mmol/L).
Other presentations
Although uncommon, fatal salicylate poisoning from topical application of joint liniments containing methyl salicylate has been known to occur. The presence of a contact dermatitis may be a vital clue in such cases.
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