The trajectory of serum salicylate concentrations after ingestion of medicinal oil containing methyl salicylate.

IF 3 3区 医学 Q2 TOXICOLOGY
Clinical Toxicology Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI:10.1080/15563650.2024.2409826
Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Anthony T Y Chow, Esther W Y Chan, Timothy Hudson Rainer
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引用次数: 0

Abstract

Introduction: The toxicokinetics of methyl salicylate after unintentional or intentional ingestion of medicinal oil containing methyl salicylate has not been well studied. We aimed to characterize the trajectory of serum salicylate concentrations and to evaluate factors associated with the peak serum salicylate concentration and the time from ingestion to peak concentration.

Methods: This was a retrospective cohort study of consecutive patients reported to the Hong Kong Poison Control Centre for laboratory-confirmed methyl salicylate poisoning by all local public emergency departments between 1 July 2008 and 30 June 2023. We analyzed cases with at least three serum salicylate concentrations. Multivariable generalized linear regression was used to identify factors significantly associated with the peak serum concentration and the time from ingestion to peak concentration.

Results: We included 41 patients (median age 81.0 years; 32 women and nine men). The median time from ingestion to the first peak serum salicylate concentration was 5.6 h (IQR: 3.2-10.8 h). Multiple regression showed that gastric aspiration (adjusted regression coefficient [β] - 2.50; 95% CI: -3.93 to -1.08; P = 0.001) and single-dose activated charcoal (adjusted β - 1.22; 95% CI: -2.02 to -0.42; P = 0.003) were significantly associated with a lower peak concentration, after adjusting for patient age, sex, exposure due to intentional self-harm, reported ingested dose, time from ingestion to emergency department presentation, vomiting, concurrent use of aspirin (acetylsalicylic acid) and other medications that affect gastric emptying or gastric acid secretion, blood pH, serum albumin concentration, and creatinine clearance.

Discussion: The serum salicylate concentration did not peak as quickly as generally believed, highlighting the importance of continued monitoring. Gastric aspiration and single-dose activated charcoal may help reduce gastrointestinal absorption, but their impact on clinical outcomes remains unclear.

Conclusions: Given the median time of 5.6 h (IQR: 3.2-10.8 h) from ingestion to the peak salicylate concentration, gastric aspiration and single-dose activated charcoal can be considered in patients up to a few hours after medicinal oil ingestion when the airway is protected.

摄入含水杨酸甲酯的药油后血清中水杨酸盐浓度的变化轨迹。
简介:无意或有意摄入含有水杨酸甲酯的药油后,水杨酸甲酯的毒物动力学尚未得到充分研究。我们旨在描述血清水杨酸盐浓度的变化轨迹,并评估与血清水杨酸盐浓度峰值以及从摄入到浓度峰值的时间相关的因素:这是一项回顾性队列研究,研究对象是在2008年7月1日至2023年6月30日期间,所有本地公共急诊部门向香港中毒控制中心报告并经实验室确诊为水杨酸甲酯中毒的连续患者。我们分析了血清中水杨酸盐浓度至少达到三次的病例。我们使用多变量广义线性回归来确定与血清浓度峰值和从摄入到浓度峰值的时间有显著相关的因素:我们共纳入了 41 名患者(中位年龄 81.0 岁;32 名女性和 9 名男性)。从摄入到血清水杨酸盐浓度首次达到峰值的中位时间为 5.6 小时(IQR:3.2-10.8 小时)。多元回归显示,胃吸入(调整后的回归系数 [β] - 2.50;95% CI:-3.93 至 -1.08;P = 0.001)和单剂量活性炭(调整后的β - 1.22;95% CI:-2.02 至 -0.42;P = 0.在调整了患者年龄、性别、故意自残导致的暴露、报告的摄入剂量、摄入到急诊科就诊的时间、呕吐、同时服用阿司匹林(乙酰水杨酸)和其他影响胃排空或胃酸分泌的药物、血液pH值、血清白蛋白浓度和肌酐清除率后,水杨酸盐浓度峰值较低与单剂量活性炭(调整后β - 1.22;95% CI:-2.02 至 -0.42;P = 0.003)有显著相关性:讨论:血清水杨酸盐浓度并不像一般认为的那样迅速达到峰值,这突出了持续监测的重要性。胃吸痰和单剂量活性炭可能有助于减少胃肠道吸收,但它们对临床结果的影响仍不明确:鉴于从摄入到水杨酸盐浓度达到峰值的中位时间为 5.6 小时(IQR:3.2-10.8 小时),因此在保护呼吸道的情况下,可以考虑在患者摄入药用油后几小时内进行胃抽吸和单剂量活性炭处理。
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来源期刊
Clinical Toxicology
Clinical Toxicology 医学-毒理学
CiteScore
5.70
自引率
12.10%
发文量
148
审稿时长
4-8 weeks
期刊介绍: clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
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