Salicylate-induced pulmonary edema: clinical characteristics in children

A five-year retrospective study of pediatric salicylate intoxications (serum level greater than 300 micrograms/ml) revealed that 2/20 patients developed salicylate induced pulmonary edema. These patients had significantly higher initial anion gaps (P less than 0.02) and serum salicylate determinations (P less than 0.001) and tended to be younger with lower initial serum potassium and arterial carbon dioxide measurements. Both patients in the salicylate-induced pulmonary edema group died, whereas none in the non-pulmonary edema group died. Unlike other reports, these data suggest that pulmonary edema is not rare in severe pediatric salicylate ingestion and correlates with high serum salicylate levels and anion gaps. Early, aggressive detoxification, supportive therapy, and hemodynamic monitoring would appear to be indicated in these patients.