SALICYLATE TOXICITY IN THE OLDER PATIENT

Nonacetylated salicylates are frequently used in the treatment of musc uloskeletal complaints and pain management in older patients because o f their possible lower gastrointestinal and renal toxicity as compared with other nonsteroidal anti-inflammatory agents. We report five pati ents with chronic salicylate intoxication seen at the Atlanta VA Medic al Center. All charts of patients diagnosed with salicylate toxicity w ere reviewed, and cases with acute, intentional intoxication were excl uded. In the study group, three patients took a nonacetylated salicyla te, the other two took an acetylated salicylate. Our patients ranged i n age from 51 to 78 years old. One patient died of respiratory failure and ''sepsis-like syndrome,'' a potentially lethal complication of sa licylate toxicity. Few: of the patients had altered mental status as a presenting complaint. The presence of a combined respiratory alkalosi s and metabolic acidosis, present in all. five patients, was the clue for diagnosis in three of the cases. Tinnitus was reported in only one patient. A significantly decreased urate level and a wide anion gap w ere consistent findings as well. Two of the patients improved after hy dration and discontinuation of use of the drug, two required alkaliniz ation of the urine, and one required dialysis. Clinicians need to be m ore aware of the potential toxicity, including life-threatening compli cations, with the use of salicylates, particularly in high risk popula tions such as elderly patients and patients with multiple medical prob lems.