Medicated oils and severe salicylate poisoning: quantifying the risk based on methyl salicylate content and bottle size.

In Hong Kong, medicated oils containing methyl salicylate account for 48% of acute salicylate poisoning cases treated in the general medical ward of the Prince of Wales Hospital. To quantify better the risk to average persons who have intentionally ingested these medicated oils, the methyl salicylate content and bottle size of 7 commonly available formulations were examined. Koong Yick Hung Far Oil had the highest methyl salicylate content (67%) and was available only in 60-ml bottles. If the entire bottle of this product were ingested, the equivalent of 184 adult 300-mg aspirin tablets would have been swallowed. Accidental ingestions of as little as 6 ml of Koong Yick Hung Far Oil by a child can be fatal. Six other products contained 15-40% methyl salicylate and their biggest bottle sizes range from 28-57 ml. Among medicated oils commonly found in Hong Kong, Koong Yick Hung Far Oil poses the greatest threat for severe salicylate poisoning if swallowed because of its high salicylate content and its availability in 60-ml bottles. The threat from medicated oils can probably be reduced by restricting their bottle size and methyl salicylate concentration. Physicians and clinical toxicologists should appreciate the toxic potential of these products.