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Case 1: Mysteriously Rising Salicylate Levels in a 15-year-old Girl

Veronica Parker, Deborah Goldberg and Marta A. King
Pediatrics in Review June 2017, 38 (6) 280-281; DOI: https://doi.org/10.1542/pir.2014-0129
Veronica Parker
*Cardinal Glennon Children’s Hospital, St Louis, MO
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Deborah Goldberg
*Cardinal Glennon Children’s Hospital, St Louis, MO
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Marta A. King
*Cardinal Glennon Children’s Hospital, St Louis, MO
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  1. Veronica Parker, MD*
  2. Deborah Goldberg, MD*
  3. Marta A. King, MD, MEd*
  1. *Cardinal Glennon Children’s Hospital, St Louis, MO
  • AUTHOR DISCLOSURE

    Drs Parker, Goldberg, and King have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 15-year-old girl with a history of depression and self-harm is found surrounded by empty pill bottles approximately 1 hour after ingestion. She admits to taking approximately 25 tablets of aspirin (acetylsalicylic acid) 325 mg (135 mg/kg), 2,000 mg of ibuprofen, and “a few stomach pills” with the intent to commit suicide. Two hours after ingestion, she notes abdominal pain but is otherwise alert, oriented, and breathing comfortably at a community hospital. Her initial serum salicylate level is 32.5 mg/dL 4 hours after ingestion. She is transferred to a tertiary facility, where she notes abdominal pain, nausea, and now ringing in her ears.

On examination, she has a temperature of 97.8°F (36.6°C), blood pressure of 101/60 mm Hg, pulse of 112 beats/min, and respiratory rate of 18 breaths/min. She answers questions appropriately. Abdominal examination elicits diffuse mild tenderness, normal bowel sounds, and no masses. Motor and sensory examination findings are normal, and she exhibits normal reflexes.

Laboratory findings reveal a serum bicarbonate level of 21 mEq/L (21 mmol/L), a negative acetaminophen level, a urine drug screen positive for cannabinoids, and, 6 hours after ingestion, a serum salicylate level of 40.7 mg/dL. Nine and 11 hours after ingestion, the serum salicylate level remains at 40.7 mg/dL.

The patient is admitted to the PICU for intravenous (IV) fluid administration, alkalinization, and observation. She becomes tachypneic. A repeated salicylate level determined 14 hours after ingestion is 45.0 mg/dL. An abdominal radiograph is taken (Fig 1) that helps to make the diagnosis.

Figure 1.

Bezoar seen in the antrum of the stomach.

Discussion

Late elevation of salicylate levels made us concerned for unabsorbed drug. Further history …

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Pediatrics in Review: 38 (6)
Pediatrics in Review
Vol. 38, Issue 6
1 Jun 2017
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Case 1: Mysteriously Rising Salicylate Levels in a 15-year-old Girl
Veronica Parker, Deborah Goldberg, Marta A. King
Pediatrics in Review Jun 2017, 38 (6) 280-281; DOI: 10.1542/pir.2014-0129

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Case 1: Mysteriously Rising Salicylate Levels in a 15-year-old Girl
Veronica Parker, Deborah Goldberg, Marta A. King
Pediatrics in Review Jun 2017, 38 (6) 280-281; DOI: 10.1542/pir.2014-0129
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