a Oregon Poison Center , Portland , OR , USA.
b Department of Emergency Medicine , Oregon Health & Science University , Portland , OR , USA.
Clin Toxicol (Phila). 2019 Feb;57(2):137-140. doi: 10.1080/15563650.2018.1502442. Epub 2018 Oct 11.
Salicylates are usually rapidly absorbed and quickly measurable in serum. An undetectable serum salicylate concentration ([ASA]) may occur early after ingestion and may be interpreted as evidence of non-exposure and not repeated. Although cases of delayed salicylate detection are reported rarely, the risk factors associated with this phenomenon are not known.
What factors are associated with an early undetectable [ASA] in salicylate poisoning?
Records from a single regional poison center were searched from 2002 to 2016 for cases of salicylate toxicity treated with bicarbonate and [ASA] > 30 mg/dL. Cases were excluded if initial [ASA] was obtained >4 h after presentation. Case information, serial [ASA], and outcomes were recorded and compared between groups.
A total of 313 records met all criteria with 11 initially undetectable [ASA] (3.5%) and 302 detectable [ASA] (96.5%). Time of first [ASA] occurred sooner in the undetectable [ASA] group (89 vs. 137 min, p = 0.011) while time to peak [ASA] was longer (640 vs. 321 min, p < .001). The longest interval between ingestion and undetectable [ASA] was 225 min. Peak [ASA] and reported mean ingested dose were similar in both groups (45 vs. 50 mg/dL, p = NS; 19.7 g vs. 32.9 g, p = NS). Coingestion of agents that delay gastric emptying were similar in both groups (18% [2/11] vs. 25% [76/302], p = NS, chi-square). Hemodialysis was performed in 9% (1/11) of undetectable [ASA] patients and 5.6% (17/302) of detectable [ASA] patients (p = NS, chi-square). A single death occurred in the entire cohort in a patient with an initially detectable [ASA].
In this series, a small but significant proportion (3.5%) of patients who developed [ASA] > 30 mg/dL had an initially undetectable [ASA]. Those with an undetectable [ASA] were measured earlier after ingestion with a longer time to peak [ASA]. However, neither coingestion of agents prolonging gastric emptying nor reported dose ingested was different between groups. Formulation was infrequently recorded but one undetectable [ASA] did ingest a non-enteric coated product. Limitations include the small number of patients with undetectable [ASA], use of single poison center data and partial data on co-ingestants and aspirin formulation.
[ASA] may be undetectable early after an overdose and need for serial [ASA] in the evaluation of salicylate ingestion should be further explored. Additional research is needed to determine any causative factors and the optimal timing of [ASA] measurements.
水杨酸盐通常在血清中被快速吸收并迅速测量。摄入后早期可能出现无法检测到的血清水杨酸盐浓度 ([ASA])，这可能被解释为未暴露和未重复的证据。尽管有报道称很少有延迟检测到水杨酸盐的情况，但与这种现象相关的危险因素尚不清楚。
水杨酸盐中毒中哪些因素与早期无法检测到 [ASA] 有关？
从 2002 年至 2016 年，对接受碳酸氢盐治疗且 [ASA] > 30mg/dL 的单一地区中毒中心的记录进行了搜索。如果初始 [ASA] 在出现后 >4 小时获得，则排除病例。记录病例信息、连续 [ASA] 和结果，并比较组间差异。
共有 313 份记录符合所有标准，其中 11 份最初无法检测到 [ASA]（3.5%），302 份可检测到 [ASA]（96.5%）。无法检测到 [ASA] 组的首次 [ASA] 时间更早（89 分钟与 137 分钟，p=0.011），而峰值 [ASA] 时间更长（640 分钟与 321 分钟，p < 0.001）。从摄入到无法检测到 [ASA] 的最长时间间隔为 225 分钟。两组的峰值 [ASA] 和报告的平均摄入剂量相似（45 毫克/分升与 50 毫克/分升，p=NS；19.7 克与 32.9 克，p=NS）。两组中同时摄入会延迟胃排空的药物的比例相似（18% [2/11]与 25% [76/302]，p=NS，卡方检验）。在无法检测到 [ASA] 的患者中，有 9%（1/11）接受了血液透析，在可检测到 [ASA] 的患者中，有 5.6%（17/302）接受了血液透析（p=NS，卡方检验）。整个队列中只有 1 例患者在最初可检测到 [ASA] 时死亡。
在本系列中，有一小部分（3.5%）发展为 [ASA] > 30mg/dL 的患者最初无法检测到 [ASA]。无法检测到 [ASA] 的患者在摄入后更早地测量到 [ASA]，且峰值 [ASA] 时间更长。然而，同时摄入会延长胃排空的药物或报告的摄入剂量在两组之间没有差异。制剂很少被记录，但有 1 例无法检测到 [ASA] 的患者摄入了非肠溶包衣产品。本研究存在一定局限性，包括无法检测到 [ASA] 的患者数量较少、仅使用单一中毒中心的数据以及同时摄入的药物和阿司匹林制剂的部分数据。
[ASA] 可能在过量摄入后早期无法检测到，因此需要进一步探讨在评估水杨酸盐摄入时进行连续 [ASA] 检测的必要性。需要进一步研究以确定任何因果因素和最佳 [ASA] 测量时间。
