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Salicylate Intoxication in an Infant: A Case Report

Rita Espírito Santo1, Sara Vaz2,3, Filipa Jalles1

  • 1Intensive Care Unit, Paediatric Department, Hospital of Santa Maria, Lisbon, Portugal.

Drug Safety - Case Reports
|November 29, 2017
PubMed

Insights

Salicylate poisoning can mimic diabetic ketoacidosis in children, presenting with high anion gap metabolic acidosis. Early identification and treatment are crucial for managing this potentially fatal condition.

Area of Science:

  • Pediatrics
  • Toxicology
  • Emergency Medicine

Background:

  • Diabetic ketoacidosis is the most common cause of elevated anion gap metabolic acidosis with ketonemia in children.
  • Non-diabetic causes of these metabolic derangements require consideration, especially when clinical history is unclear.

Purpose of the Study:

  • To highlight salicylate intoxication as a critical differential diagnosis in pediatric patients presenting with metabolic acidosis and ketosis.
  • To emphasize the importance of a thorough toxicological history in pediatric emergencies.

Main Methods:

  • Case report of a 9-month-old infant presenting with severe metabolic acidosis.
  • Clinical examination, blood gas analysis, urine and blood tests for ketones, glucose, and salicylate levels.
  • Review of clinical presentation and management of salicylate poisoning.

Main Results:

  • The infant presented with Kussmaul breathing, tachycardia, fever, and elevated anion gap metabolic acidosis.
  • Laboratory findings included ketonemia, ketonuria, glycosuria, and hyperglycemia, initially suggestive of diabetic ketoacidosis.
  • Plasma salicylate levels confirmed toxic levels, revealing accidental salicylate poisoning as the cause.

Conclusions:

  • Salicylate intoxication can present with signs and symptoms mimicking diabetic ketoacidosis in children.
  • Accurate and rapid diagnosis, including toxicological screening, is vital for appropriate management and improved outcomes.
  • Despite declining incidence, salicylate poisoning remains a significant cause of pediatric morbidity and mortality.

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