The clinical value of screening for salicylates in acute poisoning

In this retrospective study, we evaluated the clinical value of screening for salicylates in 347 patients with acute poisoning presenting to the Prince of Wales Hospital, Hong Kong, between January 1992 and June 1993. In 83 patients (24%), ingestion of salicylates was suspected; the incidence of elevated plasma salicylate concentrations (> 0.1 mmol/L) in those who had taken identifiable drugs, unidentifiable drugs but known type, or topical medicaments was 71%, 16% and 61%, respectively. In 264 patients (76%), ingestion of salicylates was not suspected, and of these, 3 had elevated (0.2-0.4 mmol/L) plasma salicylate concentrations. Routine screening for salicylates in all patients with acute poisoning in Hong Kong appears unnecessary, especially as many authorities consider that 1 of the main indications for treating salicylate poisoning is clinical evidence of toxicity. Restricting plasma measurements to only those suspected of having ingested salicylates would have saved up to 76% of requests. All physicians should be aware of the high salicylate content of some Chinese proprietary topical medicaments.