Severe Salicylate Poisoning Due to Teaberry Flavoring Ingestion: A Case Report

There are currently many commercial uses for methyl salicylate, including fragrances, flavoring, topical pain relief, and polymer restoration. Most recorded cases of human toxicity due to methyl salicylate are the result of topical or accidental exposures. However, this is a previously unreported case of an adult patient who intentionally ingested teaberry flavoring, causing life-threatening salicylism.

A 22-year-old man presented to the emergency department with the chief symptoms of nausea, vomiting, and abdominal pain. Triage nursing noted the patient's vomit smelled strongly of wintergreen. Further history indicated the patient had ingested approximately 40 mL of teaberry oil while using it to make ice cream. The initial serum salicylate concentration was 111 mg/dL. The medical toxicology team was consulted, and the patient was given a singular dose of activated charcoal by mouth. He was also administered both an intravenous sodium bicarbonate bolus and sodium bicarbonate infusion. He was admitted to the intensive care unit and the nephrology service was consulted to initiate emergent hemodialysis. After the single hemodialysis treatment with concomitant serum and urine alkalization, the patient had progressive improvement of salicylate concentrations. He was discharged on hospital day 3 in normal condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of novel etiologies of life-threatening salicylate poisoning.