Case Presentation:
The incidence of acute salicylate intoxication in children has declined (mortality reduction 34%) with limitation of the dose of aspirin in tablets and child resistant packaging. However, salicylate containing products like incense and candles are found in most households and can be a source of intoxication A 3 years old girl presented to the ER after first episode of non‐febrile, generalized tonic clonic seizure. Examination was within normal limits. ABG revealed respiratory alkalosis with metabolic acidosis. Initial investigation revealed serum salicylate level of 19mg/dl with a repeat after 5 hours of 17mg/dl. She had two episodes of seizures in the PICU, one resolved spontaneously in 40secs, following which she was loaded with Levetiracetam. She then had another seizure 3 hours later which lasted for 7 minutes and resolved with Lorazepam. On neurologist’s recommendation, she was started on Fosphenytoin. Parents denied any other symptoms, prior head injury or exposure to any known toxin. Milestones were normal. EEG and MRI brain were normal. Administration for Children’s Services investigated the home and found chronic exposure to incense stick (salicylates 10‐20%) fumes continuously in the room. No other contributory sources were reported. Poison Control was informed. Further exposure to incense sticks was stopped and parents were counseled, thereafter she had no seizures and resumed normal growth on follow up.
Discussion:
Chronic salicylate intoxication occurs with lower serum concentrations as, over time, a larger amount of salicylate is distributed to tissues. Although there is no absolute correlation between the plasma salicylate concentration and symptoms, signs of intoxication are seen when the concentration exceeds 25mg/dL. Life threatening complications of intoxication may be seen while plasma concentrations are declining and clinicians must follow patients closely.
Conclusions:
All salicylate‐containing products should have an appropriate warning label. It is important that health care providers are aware of the potential risk.