salicylates and Delirium

BACKGROUND Over-the-counter medications that contain aspirin are widely used, and patients generally regard them as safe. However, the side effects of salicylate toxicity can be severe, and delay in the diagnosis may increase the risk of mortality. Neurologic symptoms are a common presenting feature of salicylate toxicity in the elderly, and their recognition may allow earlier diagnosis. This report is of a case of a 61-year-old woman who presented with acute focal neurologic deficit associated with salicylate toxicity and who had a previous history of stroke. CASE REPORT A 61-year-old woman presented to the Emergency Department after awakening with left-sided weakness. She had a history of ischemic stroke with an associated seizure disorder. The patient denied recent seizure, and brain magnetic resonance imaging (MRI) showed no evidence of an acute stroke. Following her arrival, she became acutely confused and complained of tinnitus, shortness of breath, and blurred vision. On direct questioning, she gave a history of excessive use of salicylate for the previous two to three weeks. Her initial serum salicylate level was significantly increased at 78.1 mg/dl (upper therapeutic limit, 19.9 mg/dl). She recovered completely following treatment with oral activated charcoal, intravenous sodium bicarbonate, and potassium replacement. CONCLUSIONS This case demonstrates that physicians should consider salicylate toxicity as a possible cause of exacerbation of neurological deficit in elderly patients.

Topics: Charcoal; Delirium; Female; Humans; Middle Aged; Neurologic Examination; Neurotoxicity Syndromes; Paresis; Potassium; Salicylates; Sodium Bicarbonate; Stroke; Tinnitus

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Delirium; Drug Overdose; Emergency Service, Hospital; Fatigue; Female; Humans; Muscle Weakness; Neuropsychological Tests; Renal Dialysis; Salicylates; Tinnitus

Topics: Ataxia; Bismuth; Confusion; Delirium; Dyspepsia; Gait; Humans; Male; Memory Disorders; Middle Aged; Organometallic Compounds; Remission, Spontaneous; Salicylates; Tremor

Chronic salicylate intoxication represents an unappreciated form of self-poisoning in the elderly and therefore poses a diagnostic challenge. This report describes an elderly female with chronic salicylism who presented with unexplained delirium, dysarthria, diminished short-term memory and hearing, and urinary and fecal incontinence. She was treated with intravenous hydration, urinary alkalinization, and subsequent hemodialysis for persistent aciduria, acidemia and impending circulatory collapse. Major morbidity included myocardial infarction, life-threatening dysrhythmias, and mixed bacterial urosepsis. This report highlights the need to maintain a high index of suspicion for salicylate poisoning in the elderly, who commonly present with nonfocal neurologic features.

Topics: Aged; Delirium; Dysarthria; Fecal Incontinence; Female; Hearing Loss, Functional; Humans; Memory Disorders; Salicylates; Urinary Incontinence

Physicians should question their elderly patients and those who know their life-styles and habits best (ie, family, friends, caretakers) regarding use of over-the-counter medications. Salicylates are commonly used by the elderly, and long-term unsupervised use may lead to salicylate toxicity that can cause delirium. In the southern United States, BC and Goody's Headache Powders are widely marketed and used, and their overuse can produce salicylate intoxication.

Topics: Aged; Aged, 80 and over; Chronic Disease; Delirium; Female; Humans; Middle Aged; Nonprescription Drugs; Salicylates

Topics: Caffeine; Delirium; Humans; Quinuclidinyl Benzilate; Salicylates; Salicylic Acid

Topics: Delirium; Humans; Male; Middle Aged; Salicylates; Substance-Related Disorders