• 
• 

Three Part Question

In [alert adults with full mental capacity] who [present to the Emergency Department with overdose - but deny taking salicylates] - is there [evidence for a need to check serum salicylate levels?]

Clinical Scenario

27 y.o. female is brought to your emergency department following ingestion of Celexa. She ingested approximately 25, 20mg tablets 3 hours ago following an argument with her boyfriend. She denies any co-ingestants. She denies any symptoms. Physical examination is unremarkable. She is alert and well oriented. As you enter your orders you wonder, what is the utility of checking a salicylate level on an alert patient who denies ingestion of salicylates?

Search Strategy

Medline using OVID interface
((salicylates or aspirin) and (testing or levels or routine) and (overdose or poisoned or suicidal)).mp.

Search Outcome

32 papers found of which 4 were relevent

Comment(s)

Although routine toxicological screening in all overdose patients frequently identifies unsuspected drugs, findings are rarely of clinical importance. The three exceptions in Sporer's study all had AMS and elevated anion gaps on admission. These patients were later diagnosed with chronic salicylate poisoning. These papers suggest patient history is sensitive for the detection of salicylate ingestion. Furthermore, clinically significant salicylate ingestion's present with AMS and/or signs and symptoms of salicylate toxicity.

Clinical Bottom Line

Routine screening for salicylates is unnecessary in patients with a suicidal ingestion who deny salicylate ingestion, are alert and well oriented, and lack signs and symptoms of salicylate toxicity.