PEDIATRICS Vol. 70 No. 4 October 1982, pp. 566-569
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The Relative Severity of Acute Versus Chronic Salicylate Poisoning in Children: A Clinical Comparison

Pierre Gaudreault MD1, Anthony R. Temple MD1, and Frederick H. Lovejoy Jr MD1

1 Department of Medicine and Clinical Pharmacology/Toxicology Unit, The Children's Hospital Medical Center, and Department of Pediatrics and Pharmacology, Harvard Medical School, Boston; and Department of Pediatrics, The University of Utah Medical Center, Salt Lake City

To evaluate the relative severity of acute vs chronic salicylate poisoning in children, 112 Cases (65 acute and 47 chronic) of salicylate poisoning (salicylate concentration ge20 mg/100 ml) admitted to The Children's Hospital Medical Center in Boston and Primary Children's Medical Center in Salt Lake City between the years 1967 and 1978 were analyzed. Hyperventilation (P < .01), dehydration (P < .001), and severe central nervous system manifestations (P < .001) occurred more frequently in the chronic group and remained more frequent (P < .01) when patients having disease states capable of producing these signs and symptoms were removed from statistical analysis. At three separate salicylate concentration ranges (20 to 39, 40 to 59, and ge60 mg/100 ml) hyperventilation, dehydration, and severe CNS manifestations tended to occur with greater frequency in the chronic group. When severity of salicylate poisoning was categorized based on a combination of signs and symptoms, mild cases predominated in the acute group whereas severe cases occurred more frequently in the chronic group. Finally, systemic acidosis (pH < 7.32) was found more frequently in the chronic group (P < .01), more frequently in patients with severe manifestations than in those with mild manifestations, and in patients with dehydration (P < .01) and severe CNS manifestatations (P < .05). Based on the variables evaluated, chronic salicylism produces a greater morbidity than does acute salicylate poisoning in the pediatric patient.

Submitted on September 8, 1981
Accepted on October 26, 1981




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