Seizures from Chronic Salicylate Intoxication Following Household Exposure to Incense Fumes

BACKGROUND The incidence of acute salicylate intoxication in children has declined following regulatory measures such as limiting the aspirin content per tablet and the introduction of child-resistant packaging. However, salicylate-containing household products - such as incense sticks and scented candles - remain common potential sources of exposure. CASE REPORT We report the case of a 3-year-old girl who presented to the emergency department after her first episode of a non-febrile, generalized tonic-clonic seizure. Physical examination was unremarkable. Arterial blood gas analysis demonstrated a mixed picture of respiratory alkalosis with metabolic acidosis. Her initial serum salicylate concentration was 19 mg/dL, decreasing to 17 mg/dL on repeat testing 5 hours later. During her stay in the pediatric intensive care unit, she experienced 2 additional seizures and was started on fosphenytoin. The parents denied any history of head injury, prior illness, or known toxin exposure. Developmental milestones were age appropriate. Electroencephalogram and MRI of the brain were normal. A subsequent home investigation by Administration for Children's Services identified regular exposure to incense stick fumes containing 10-20% salicylates as the likely source of chronic intoxication; no other sources were identified. Poison Control was notified. Following cessation of incense use and parental counseling, the child remained seizure-free and continued normal development on follow-up. CONCLUSIONS All salicylate-containing products should carry clear and appropriate warning labels regarding potential toxicity. Health care providers should remain vigilant and consider environmental and household sources of salicylate exposure when evaluating unexplained metabolic acidosis or new-onset seizures in children.