53, 83 There was also a marked increase in oxygen consumption in mice even with low salicylate concentrations, highlighting the importance of salicylate induced uncoupling of oxidative phosphorylation.
Salicylate poisoned mice had dramatic increases in serum lactate concentration compared with control mice, likely because of increased glycogenolysis and anaerobic glycolysis to compensate partly for the energy loss caused by uncoupling of oxidative phosphorylation. 17 Patients with methyl salicylate exposure have died in less than 6 hours, emphasizing the need for early determinations of salicylate concentrations in addition to frequent testing after such exposures. The onset of symptoms usually occurs within 2 hours of ingestion. 129 Vomiting is common, along with abdominal discomfort. Despite rapid and complete absorption, serum concentrations of salicylates are much less than predicted after ingestion of methyl salicylate containing liniment compared with oil of wintergreen. 16 Methyl salicylate is rapidly absorbed from the GI tract, and much, but not all, of the ester is rapidly hydrolyzed to free salicylates. In Hong Kong, medicated oils containing methyl salicylate accounted for 48% of acute salicylate poisoning cases treated in one hospital. The minimum toxic salicylate dose of approximately 150 mg/kg body weight can almost be achieved with 1 mL of oil of wintergreen, which represents 140 mg/kg of salicylates for a 10-kg child. Ingestion of methyl salicylate may be disastrous because 1 mL of 98% oil of wintergreen contains an equivalent quantity of salicylate as 1.4 g of aspirin. Despite this decline in reported deaths and general use, it is still imperative that clinicians are adept at early recognition and swift management of patients with salicylate overdose. In the last 5 years of data available (2008–2012), there were 20 to 30 deaths per year reported ( Chap. The association with Reye syndrome safer packaging and the increased use of nonsteroidal antiinflammatory drugs (NSAIDs), APAP, and other alternatives to aspirin has decreased the incidence of unintentional salicylate poisoning. Salicylate toxicity and fatalities have long been a major toxicological “concern.” From the 1950s to 1970s, salicylate was the leading cause of fatal childhood poisoning. Analgesics, which include both aspirin and acetaminophen (APAP), continue to rank first among pharmaceuticals most frequently reported in human exposures ( Chap.
The American Association of Poison Control Centers (AAPCC) National Poison Data System (NPDS) collects and reports annual exposure data in the United States.
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