The Relative Severity of Acute Versus Chronic Salicylate Poisoning in Children: A Clinical Comparison

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Abstract
To evaluate the relative severity of acute vs chronic salicylate poisoning in children, 112 Cases (65 acute and 47 chronic) of salicylate poisoning (salicylate concentration ≥20 mg/100 ml) admitted to The Children's Hospital Medical Center in Boston and Primary Children's Medical Center in Salt Lake City between the years 1967 and 1978 were analyzed. Hyperventilation (P < .01), dehydration (P < .001), and severe central nervous system manifestations (P < .001) occurred more frequently in the chronic group and remained more frequent (P < .01) when patients having disease states capable of producing these signs and symptoms were removed from statistical analysis. At three separate salicylate concentration ranges (20 to 39, 40 to 59, and ≥60 mg/100 ml) hyperventilation, dehydration, and severe CNS manifestations tended to occur with greater frequency in the chronic group. When severity of salicylate poisoning was categorized based on a combination of signs and symptoms, mild cases predominated in the acute group whereas severe cases occurred more frequently in the chronic group. Finally, systemic acidosis (pH < 7.32) was found more frequently in the chronic group (P < .01), more frequently in patients with severe manifestations than in those with mild manifestations, and in patients with dehydration (P < .01) and severe CNS manifestatations (P < .05). Based on the variables evaluated, chronic salicylism produces a greater morbidity than does acute salicylate poisoning in the pediatric patient.

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