Chronic salicylate intoxication. A common cause of morbidity in the elderly

We reviewed the clinical profile of adults with chronic salicylate intoxication by evaluating the experience of our community teaching hospital between 1977 and 1987. Data on similar patients reported was obtained from an English-language literature search using MEDLINE (1966-88) and bibliographic reviews of textbooks and review articles. We also examined the impact of education and incentive on increasing the awareness and ability of physicians to diagnose the disorder. Chronic salicylate intoxication was defined by 1) a compatible clinical syndrome; 2) a serum level in the toxic range; and 3) improvement with withdrawal of the drug. Patients with chronic salicylism represent a cross-section of an elderly population. Our review suggests that diminished body mass, concurrent administration of drugs and conditions which exacerbate renal insufficiency may predispose to salicylate intoxication; however, few specific precipitants of chronic salicylism were recognized. Salicylate intoxication should be considered in all elderly patients with delirium and/or dementia.