Chronic salicylism resulting in noncardiogenic pulmonary edema requiring hemodialysis

Salicylate intoxication is frequently overlooked as a cause of noncardiogen ic pulmonary edema and altered mental status in adult patients. We describe a 42-year-old woman who presented with two episodes of recurrent noncardio genic pulmonary edema requiring intubation. The first admission to hospital triggered an extensive initial workup that did not Indicate a cause for th e pulmonary edema. At the second presentation, recognition of the clinical syndrome in the emergency department led to the correct diagnosis of salicy late Intoxication. The patient was successfully treated with hemodialysis a nd urinary alkalinization, leading to rapid resolution of pulmonary edema a nd extubation. Several aspects of the clinical presentation suggest that th e patient suffers from chronic salicylism, probably complicated by episodic superimposed acute intoxication, a condition often misdiagnosed or diagnos ed late in the course of disease, contributing to substantial morbidity and mortality in these patients. Maintenance of a high Index of suspicion and rapid institution of appropriate therapy including hemodialysis once the di agnosis is established is an important determinant of outcome in this serio us but underdiagnosed disorder. (C) 2000 by the National Kidney Foundation, Inc.