Acute on Chronic Salicylate Toxicity: Multi-Organ Repercussions

Taylor SM* and DeMoss D

Department of Psychiatry, John Peter Smith Health Network, USA

^*Correspondance to: Stephanie M Taylor 

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Abstract:

This 38-year-old female presented to the Psychiatric Emergency Center with gradual onset pallor, agitation, jaundice, concentration impairment, disorientation, auditory and visual hallucinations that worsened over the last three days. Labs were significant for profound macrocytic anemia with a mean corpuscular volume of 135.8 fL and an initial salicylate level of 20.1 mg/dL. Her medical history was significant for back pain. She had been regularly taking over-the-counter salicylate products for 20 years to manage pain. She was medically admitted for delirium. Her mentation returned to baseline after stopping salicylate products, administration of intravenous fluids, and a one-time administration of cyanocobalamin 1000 mcg intramuscularly. This 3-day admission for delirium compounded other unusual and extreme symptom presentations over the past five years. She had other admissions for a severe high grade pyloric stenosis requiring surgical intervention, nausea and vomiting with weight loss of over 30 pounds in three months, delirium, severe constipation with new onset hypothyroidism, colitis, microcytic anemia, and acute hypoxemic respiratory failure due to acute noncardiogenic pulmonary edema. Outside of the acute-care setting, she saw primary care, psychiatric, pain management, gastroenterology, and gynecology providers. However, chronic salicylate use went unrecognized. In addition to neuropsychiatric symptoms, chronic salicylate use can cause a variety of medical problems including thyroid dysfunction, gastrointestinal problems, and respiratory complications. Normal salicylate levels do not rule out chronic salicylate toxicity. Providers should consider acute on chronic salicylate toxicity, regardless of the salicylate level, in patients with altered mental status and in patients with conspicuous medical symptoms

Keywords:

Salicylates; Toxicity; Acute on chronic; Neuropsychiatric symptoms; Delirium; Acute on Chronic Salicylate Toxicity; Multi-Organ Repercussions

Cite the Article:

Taylor SM, DeMoss D. Acute on Chronic Salicylate Toxicity: Multi-Organ Repercussions. Ann Clin Case Rep. 2023; 8: 2542..