Salicylate Toxicity

Salicylate toxicity is poisoning from salicylate compounds, like aspirin. The acute form is an overdose, happens quickly and is a medical emergency. The chronic form happens when salicylates build up more slowly in your body.

Salicylates (pronounced “sal-ISS-il-ates”) are common ingredients in many over-the-counter medications and health products. But they’re common in other products, too.

Salicylate toxicity, also known as salicylism, is usually treatable. But that depends on how it happened, your age, your health history and other factors. Without treatment, salicylate poisoning can cause severe complications and death.

Salicylate toxicity symptoms

There are two main forms of salicylate toxicity: acute and chronic.

The acute form happens when salicylate levels in your body rise quickly. The symptoms, going from less severe to more severe, include:

• Tinnitus (ringing in your ears) or hearing loss
• Dizziness
• Nausea and vomiting, possibly with blood in your vomit
• Faster and/or deeper breathing (hyperventilation)
• Lethargy
• Vertigo
• Headaches
• Confusion or altered mental status
• Excessive sweating
• Hallucinations
• Seizures

Experts often call hyperventilation, tinnitus and stomach symptoms the salicylate toxicity triad. It’s a tell-tale way providers can often tell salicylate toxicity apart from other conditions.

Chronic salicylate toxicity is likely to cause the following symptoms:

• Confusion or altered mental status
• Faster breathing or trouble breathing
• Fever
• Hallucinations
• Lethargy
• Tremors

Chronic salicylate toxicity happens when salicylates build up slowly in your body. The increase is faster than your body can handle, but slow enough not to cause acute symptoms.

IMPORTANT: If you suspect you or someone you’re with has salicylate toxicity symptoms, you can get help the following ways:

• If they’re awake and breathing: Call a poison control helpline. In the U.S., dial 1.800.222.1222. The call is toll-free. You can call this number even if you don’t see or feel symptoms.
• If they’re passed out or aren’t breathing: Call 911 or your local emergency services number.

Salicylate toxicity causes

Salicylate toxicity mainly happens because of medicines — including those you can get over the counter or with a prescription.

Acute salicylate toxicity in children is usually an accident. Suicide attempts are a main reason for it happening in adults.

IMPORTANT: If you’re having suicidal thoughts, there are people who want to help you. If you need someone to talk to, dial 988 in the U.S. to reach the National Suicide & Crisis Lifeline. If you feel you aren’t safe by yourself, call 911 or your local emergency services number.

The chronic form of salicylate poisoning usually happens with overuse of medical products. A major reason that occurs is because aspirin and other salicylates are in both medicines and other health products. The salicylates in the various products can add up and reach toxic levels.

What drugs are salicylates in?

Some of the most common drugs or products you can find salicylates in are:

• Aspirin (acetylsalicylic acid): Also known as ASA for short, this comes on its own in various doses. Many combination medicines and products also use it as an ingredient.
• Bismuth subsalicylate: This is the active ingredient in products for upset stomach and diarrhea. Examples include Pepto Bismol^® and the U.S. version of Kaopectate^®.
• Methyl salicylate: This is in topical products like creams, lotions and pain relief patches. It’s also an ingredient for mint scent or flavoring (in small amounts). Oil of wintergreen, an essential oil, is at least 98% methyl salicylate. The concentration is toxic if you drink it or your skin absorbs it.

Many other prescription and over-the-counter medicines contain salicylates. Some examples include:

• Aminosalicylic acid: For tuberculosis (Paser^®)
• Balsalazide: For ulcerative colitis (Colazal^®)
• Diflunisal: For osteoarthritis and rheumatoid arthritis (Dolobid^®)
• Magnesium salicylate: For back pain (Backprin^®, Percogesic^®) or water retention (Diurex^®)
• Olsalazine sodium: For ulcerative colitis (Dipentum^®)
• Phenyl salicylate: For urinary tract infections and urinary pain (Urelle^®, Uribel^®)
• Salsalate: For osteoarthritis and rheumatoid arthritis
• Sodium salicylate: For urinary tract infections and urinary pain (Azo^®, Cystex^®)
• Trolamine salicylate: For muscle aches, osteoarthritis and rheumatoid arthritis (Aspercreme^®, Mobisyl^®, Myoflex^®)

Cosmetics, skin care and hygiene products

Salicylates are a common ingredient in cosmetics, skin care and hygiene products. That’s because these chemicals are good at absorbing UV rays. Salicylates used for this purpose include the ones mentioned above, plus others, like:

• Choline salicylate
• Ethylhexyl salicylate
• Salicylamide
• Salicylic acid

Salicylates in these products usually aren’t enough to cause issues. But if you use large amounts of salicylate-containing products, that could lead to toxic effects. And if you also take medicines that contain salicylates, the amounts you get from different sources can add up.

Risk factors

The main risk factors for salicylate toxicity include:

• Age: Very young children have a higher risk of accidental overdose. And it takes less for them to overdose than it does for adults. Adults over 65 also have a higher risk because of the next two risk factors.
• Using multiple salicylate products: Salicylates are in many products, especially medicines and related products. And adults over 65 are more likely to have multiple health conditions. If multiple treatments you take contain salicylates, that can lead to chronic toxicity.
• Other health conditions: Conditions like kidney disease (which is more common in adults over 65) can make it easier to have salicylate toxicity. Your kidneys process salicylates. And toxicity can happen more easily if salicylates build up faster than your kidneys can handle.

Complications of salicylate toxicity

Salicylate toxicity has many possible complications. Several can be dangerous or even deadly. The complications can include:

• Bleeding (especially in your brain and digestive tract)
• Blood chemistry disruptions, like metabolic acidosis and alkalosis
• Brain swelling
• Coma
• Digestive tract damage, like perforations
• Irregular heart rhythms
• Kidney failure
• Low blood sugar
• Pulmonary edema
• Respiratory failure
• Seizures

How doctors diagnose salicylate toxicity

Healthcare providers can diagnose salicylate toxicity by:

• Asking questions about what happened
• Doing a physical exam and neurological exam
• Doing lab testing, especially on blood and pee

Lab tests are especially important with salicylate toxicity. Your provider will run repeated blood tests to monitor salicylate levels. The results of those tests can guide treatment. Other tests are also possible, depending on your symptoms. Your healthcare provider can recommend and explain tests for your specific case.

How is salicylate toxicity treated?

There’s no antidote for salicylate toxicity. Instead, treating salicylate toxicity involves:

• Keeping your body from absorbing more salicylate
• Getting rid of what you absorbed
• Managing effects from what you absorbed

The treatments you might receive include:

• Activated charcoal (it keeps your body from absorbing salicylates in your digestive tract)
• Stomach pumping to remove salicylates
• IV fluids and medicines to manage your blood chemistry
• Medicines that help you get rid of salicylates
• Dialysis to filter excess salicylates out of your blood (with severe toxicity)
• Blood transfusions to replace lost blood (if necessary)
• Upper endoscopy or surgery to remove pills stuck together in stonelike clumps (not common)

What can I expect if I have salicylate toxicity?

What you can expect from salicylate toxicity usually depends on the amount of the overdose, how it happened and your health history. Other factors can play a role, too.

In general, the outlook for salicylate toxicity is better with fast diagnosis and treatment. Your healthcare provider can tell you more about what you should expect.

Can salicylate toxicity be prevented?

Salicylate toxicity is extremely preventable. Some key things you can do to prevent it include:

• Read the label: Medicines and health products always list salicylates that are active ingredients. And they usually list them when they’re inactive ingredients, too. If you aren’t sure if something counts, ask a pharmacist or other healthcare provider.
• Lock up medicines or products that contain salicylates: Salicylate toxicity in children is often an accident. Locking up medicines or essential oils can prevent accidents like this. And remember that putting something out of reach isn’t the same as locking it up (and isn’t as safe, either).
• Tell your healthcare providers every medicine and supplement you take: That includes over-the-counter products and medicines. They need to know about these in case they also contain salicylates.
• Ask before you use over-the-counter products: Just because something’s available over the counter doesn’t automatically mean it’s safe. Ask your healthcare provider if it’s safe to use over-the-counter products. That's key for both medicines and medicated items, like pain relief patches.