Salicylate-induced pulmonary edema.

Walters, J S; Woodring, John H.; Stelling, C B; Rosenbaum, Harold D.

doi:10.1148/radiology.146.2.6849076

Cited by 30 publications

(6 citation statements)

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“…The incidence of these toxicities may be higher, because administration was halted when hyperventilation occurred. A retrospective study [35] of 56 salicylate-intoxicated adults, with intoxication defined as a peak salicylate level у30 mg/dL, found 6 patients (11%) with noncardiogenic pulmonary edema. For adults aged 130 years, the incidence of noncardiogenic pulmonary edema was 35%.…”

Section: Aspirin Regimens (Dose and Schedule) Recommended In 1918 Arementioning

confidence: 99%

“…The occurrence of pulmonary edema in humans with salicylate intoxication is well documented [19,35]. Increased pulmonary vascular bed permeability to fluid and protein, decreases in arterial pO2, and increases in postmortem extravascular lung water followed salicylate administration in sheep [46].…”

Section: Salicylates Cause Immediate Lung Toxicity and May Predisposementioning

confidence: 99%

“…ARDS-like disease has also been reported [53]. Children with aspirin toxicity (or Reye syndrome) are less likely than adults to present with pulmonary edema [35], although in addition to brain swelling, fatty liver, and cloudy swelling of the kidneys [54,55], some have pulmonary edema [55,56], "frothy, blood-tinged fluid" [57], and lung hemorrhages [54].…”

Section: The Pathology Of the Early Deaths Is Consistent With Aspirinmentioning

confidence: 99%

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Salicylates and Pandemic Influenza Mortality, 1918–1919 Pharmacology, Pathology, and Historic Evidence

Starko

2009

CLIN INFECT DIS

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The high case-fatality rate--especially among young adults--during the 1918-1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely "wet," sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0-31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.

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Section: Aspirin Regimens (Dose and Schedule) Recommended In 1918 Arementioning

confidence: 99%

Section: Salicylates Cause Immediate Lung Toxicity and May Predisposementioning

confidence: 99%

Section: The Pathology Of the Early Deaths Is Consistent With Aspirinmentioning

confidence: 99%

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Salicylates and Pandemic Influenza Mortality, 1918–1919 Pharmacology, Pathology, and Historic Evidence

Starko

2009

CLIN INFECT DIS

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“…Salicylate‐induced pulmonary edema has been observed in humans [24–29] and studied in animals [30,31]. The human observations indicate noncardiogenic pulmonary edema with low cardiac filling pressures and a high protein, transudative fluid in the airways [27].…”

Section: Pathophysiologymentioning

confidence: 99%

Salicylate Intoxication

Yip

Jastremski

Dart

1997

J Intensive Care Med

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Aspirin (acetylsalicylic acid) is one of the most widely used over‐the‐counter medications. Because of its availability and widespread use, aspirin has a long history of human toxicity from accidental or intentional overdosing. According to the American Association of Poison Control Centers aspirin was implicated in 19083 exposures in 1995, with 11800 cases treated in a health care facility, and 52 associated deaths. Aspirin toxicity may be a life‐threatening condition that produces multiple system organ failure requiring treatment in an intensive care unit. Managing a patient with salicylism will challenge the skills of the critical care team, especially in the areas of life support, fluid and electrolyte balance, and acid‐base management. This article reviews the physiology, pathophysiology, acute and chronic salicylism in children and adults, and management of salicylate intoxication.

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“…Noncardiogenic pulmonary oedema due to salicylate intoxication (Heffner & Sahn 1981;Leatherman & Drage 1982;Walters et al 1983) is described mainly in those over 50 years of age, who are more likely to be ingesting salicylates on a long term basis. These individuals frequently have a history of smoking and often present with neurological symptoms such as lethargy or confusion (Hefner & Sahn 1981;Walters et al 1983).…”

Section: Pulmonarymentioning

confidence: 99%

Salicylate Intoxication in the Elderly

Durnas

Cusack

1992

Drugs & Aging

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Aspirin (acetylsalicylic acid) and its salicylate derivatives are effective antipyretic, analgesic, and anti-inflammatory agents that are still very widely used by the elderly despite the advent of newer, potentially safer nonsteroidal anti-inflammatory drugs (NSAIDs). However, none of the new NSAIDs have been proven to be more effective than aspirin or salicylic acid. Chronic salicylate intoxication which is most common in the elderly, may occur with therapeutic doses. Increased toxicity in older patients often appears due to inadvertent overdosage. Dual prescribing or additional use of nonprescription salicylates are some causes of unwitting long term toxicity. According to some studies, systemic clearance of salicylate (mainly by hepatic metabolism) is reduced with age, as is renal elimination. These changes are of increased importance in the elderly using high therapeutic doses of salicylates when metabolism is saturated and more unchanged drug is available for renal excretion. In the face of renal impairment, the risk of toxicity is increased. The diagnosis of acute salicylate intoxication generally does not pose diagnostic problems. Patients often present with a history of intentional overdose, with hyperventilation, fever, and nausea. The diagnosis can be confirmed by measuring serum salicylate concentrations. Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction or cardiac failure. The diagnosis of salicylate intoxication should be borne in mind when an older patient presents with recent deterioration in activities of daily living with no known cause. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there is no documented history of salicylate ingestion. The risk of salicylate nephrotoxicity is also increased with age, and upper gastrointestinal haemorrhage is associated with increased mortality in older age groups. Treatment of acute toxicity consists of prompt recognition of salicylate intoxication, use of activated charcoal, correction of acid-base abnormalities, general supportive measures, and if concentrations are extremely high, dialysis can be effectively used. Chronic toxicity, which can occur even with marginally high salicylate concentrations, is treated with drug withdrawal and supportive therapy. Chronic salicylate toxicity can be averted by prescription of conservative doses of drug, avoidance of concomitant use of different salicylate preparations, and therapeutic monitoring to guide dosage. Renal function should be monitored to detect nephrotoxicity from chronic salicylate therapy. Patients should be regularly screened for evidence of gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)

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Salicylate-induced pulmonary edema.

Cited by 30 publications

References 0 publications

Salicylates and Pandemic Influenza Mortality, 1918–1919 Pharmacology, Pathology, and Historic Evidence

Salicylates and Pandemic Influenza Mortality, 1918–1919 Pharmacology, Pathology, and Historic Evidence

Salicylate Intoxication

Salicylate Intoxication in the Elderly

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