LIFE-THREATENING SALICYLATE POISONING FOL LOWING PERCUTANEOUS-ABSORPTION IN A PATIENT WITH ICHTHYOSIS VULGARIS

In a 7-year-old boy, ichthyosis vulgaris was treated with a 10% ointme nt for application over a large area of the body surface. In this way, the child received 400 g salicylic acid (0.6 g/kg body weight per day ) percutaneously over a period of 4 weeks. The patient was referred to hospital by the family doctor: he was in a deep somnolent state, appa rently caused by hyperventilation following wheezing, vomiting, tinnit us and vertigo. Salicylate intoxication was suspected because of metab olic acidosis, an anion gap and respiratory overcompensation. The diag nosis was confirmed by a serum salicylate level of 985 mu g/ml (therap eutic level 150-300 mu g/ml). Following forced diuresis and alkalizati on with sodium bicarbonate, haemodialysis was unnecessary. As the sali cylate level declined to values within the therapeutic range, the pati ent started to recover conciousness, waking on the 4th day. By day 6 t here were still obvious neurological deficiencies. Fecal incontinence, bilateral ptosis and intermittent diverging strabismus on the right p ersisted for some weeks. It was 6 months before complete neurological resolution was achieved. The pathogenesis of salicylate toxicity and t he need for safer therapies for ichthyosis vulgaris are discussed.