Ciężkie zatrucie salicylanami u 7-letniej dziewczynki leczonej z powodu świerzbu maściÄ salicylowÄ

Salicylate intoxication is possible by ingestion and topical application of creams or lotions. Symptoms of salicylate poisoning include: vomiting, abdominal pain, fever, dizziness and hallucinations. Moreover metabolic acidosis or coagulations disorders can be observed. In case of severe poisoning potential symptoms may include: acute renal failure, pulmonary edema and gastrointestinal bleeding. As there is no antidote, only symptomatic treatment such as: gastric lavage, supplying with active carbon and advocated alkaline diuresis can be applied. Compensation of acid-base and electrolyte fluctuations may be of crucial importance. This paper presents the case of a 7-year-old girl, who was admitted to Department of Pediatric Cardiology and Nephrology at University of Medical Sciences in Poznan, due to intoxication by salicylates. Before hospitalization the patient was treated with 30% salicylate ointment because of scabies. After dermatological consultation, the medication was applied twice a day on whole skin except the face, without cleaning (for next three days). Patient received a total dose of 30 g of salicylic acid. First symptoms appeared after 24 hours of the first application. She was admitted to neighboring Hospital, where the preliminary diagnosis was gastro-intestinal infection. Next day the patient started to present neurological symptoms. She was transported to another hospital, where measurement of salicylates level in serum was performed. Finally the patient was admitted to Department of Pediatric Cardiology and Nephrology in Poznan for hemodialysis, due to very high, toxic level of salicylates (7 times higher than therapeutic dose of the drug). Gradual reduction of the concentration of salicylic acid in the blood serum was accompanied by clinical improvement of the patient. Because of high ratio of the skin surface to the body weight as well as clinically significant absorption into the body, substances topically applied on children with low safety margin should be dosed with caution.