Infants, Toddlers, and Aspirin

Craig, J. O.; Ferguson, I. C.; Syme, James

doi:10.1136/bmj.1.5490.757

Cited by 27 publications

(7 citation statements)

References 26 publications

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“…This is of special clinical importance because intensive salicylate therapy for these disorders requires the use of doses large enough to maintain salicylate concentrations juist below the toxic range. Indeed, serious intoxication can result from salicylate administration in the therapeutic-dose range, especially in children (1,2). On the other hand, an inadequate concentration may be the cause of therapeutic failure.…”

Section: Introductionmentioning

confidence: 99%

Salicylate Metabolism in Twins

Fürst¹,

Gupta²,

Paulus³

1977

J. Clin. Invest.

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A B S T R A C T To evaluate the contribution of genetic influences on the individual variation in plateau serum salicylate levels, salicylate metabolism was studied in seven pairs of identical and six pairs of fraternal twins.Under the conditions of this study, after a single i.v. dose (40 mg/kg) of sodium salicylate, the serum salicylate concentration versus time curve approximated a straight line on linear coordinates (appeared approximately zero order). The slopes of the decay curves ranged between 0.64 and 1.02. The intrapair variation for identical twin pairs was significantly less than for fraternal twin pairs (P = 0.044). Likewise pleateau serum salicylic acid concentrations (milligrams/deciliter) and total salicylic acid excretion rate after multiple doses demonstrated significantly less intrapair variation for identical twins than for fraternal twins (P = 0.043 and 0.006). Plateau salicylurate excretion (milligram/kilogram per hour) differences after multiple dosing had a P = 0.067. Michaelis-Menton constant for salicylurate formation and hours to 50% excretion after the i.v. dose were not different when comparing identical and nonidentical twins.Salicylurate formation rates were increased after 3 days of oral therapy, and this induction phenomenon may account for much of the apparent discrepancy between genetic influences on salicylurate formation rates observed after single and multiple dose salicylate administration.This study suggests that the plateau concentration of serum salicylate varies among individuals given the same weight-adjusted dose in part because of genetiDr. Furst's present address is the

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Section: Introductionmentioning

confidence: 99%

Salicylate Metabolism in Twins

Fürst¹,

Gupta²,

Paulus³

1977

J. Clin. Invest.

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“…3 • 16 There is considerable disagreement among clinical experts concerning the optimum dosage regimen for salicylate, particularly in children. 4 A characterization of the pharmacokinetics of salicylate elimination in man to permit rational development of safe and effective dosage regimens, is, therefore, a matter of major importance.…”

mentioning

confidence: 99%

Limited capacity for salicyl phenolic glucuronide formation and its effect on the kinetics of salicylate elimination in man

Levy

Tsuchiya

Amsel

1972

Clin Pharma and Therapeutics

201

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“…Several case reports or series with dose and effect information were identified with three of these reports being large retrospective case series (level 4) (30,105,106), and 25 being case reports or series (level 4) which described 45 other cases with sufficient detail (33,36,51,63,79,87,(107)(108)(109)(110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121)(122)(123)(124)(125). Due to differences in duration of therapy, regimen for administration, aspirin formulation, presence of underlying medical problems, and the inability to clearly define the time of onset for clinical effects, the comparison of these cases was difficult.…”

Section: Aspirinmentioning

confidence: 99%

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

Chyka

Erdman

Christianson

et al. 2007

Clinical Toxicology

115

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American Association of Poison Control Centers, Washington, District of Columbia, USAA review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected exposure to salicylates by 1) describing the process by which a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key decision elements in managing cases of salicylate exposure, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D).2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C). 4) Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, war...

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Infants, Toddlers, and Aspirin

Cited by 27 publications

References 26 publications

Salicylate Metabolism in Twins

Salicylate Metabolism in Twins

Limited capacity for salicyl phenolic glucuronide formation and its effect on the kinetics of salicylate elimination in man

Salicylate poisoning: An evidence-based consensus guideline for out-of-hospital management

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