Delayed Recrudescence to Toxic Salicylate Concentrations After Salsalate Overdose

Patrick L. West, B. Zane Horowitz

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Salicylates are common exposures. We report an unusual case of salicylate ingestion, as salsalate, with resolution of symptoms and return of salicylate levels to non-toxic values, with a subsequent, unexpected recrudescence to toxic levels requiring reinstitution of therapy. A 31-year-old man ingested unknown amounts of salsalate, hydroxyzine, and a benzodiazepine. He was intubated and treated with IV sodium bicarbonate and two doses of oral activated charcoal. Eight hours after presentation, his serum salicylate concentration peaked at 55 mg/dL, and then decreased to a nadir of 5.6 mg/dL 38 h after presentation, coinciding with return of GI motility. Several hours later salicylate concentrations began to rise, peaking 67 h after presentation at 61.7 mg/dL. He was treated with sodium bicarbonate and charcoal, which resulted in decreased serum salicylate to therapeutic levels. Salicylate ingestions are known to exhibit unusual toxicokinetics and absorption in overdose; however, this is the first case we are aware of that shows a return to toxic concentrations after apparent resolution of toxicity. Recrudescence of salicylate concentrations to a degree that would dictate reinstitution of therapy for overdose is unusual and may warrant prolonged monitoring of serum salicylate concentrations in salsalate ingestions.

Original languageEnglish (US)
Pages (from-to)150-154
Number of pages5
JournalJournal of Medical Toxicology
Issue number2
StatePublished - 2010


  • Overdose
  • Salicylates
  • Salicylsalicylic acid

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis


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