Review

Current Management of Salicylate-Induced Pulmonary Edema

Authors: James K. Glisson, MD, PharmD, Telciane S. Vesa, MD, Mark R. Bowling, MD, FACP

Abstract

Salicylate-induced pulmonary edema (SIPE) can occur in both acute and chronic users of aspirin or salicylate products. The medical history, especially when it reveals the use of salicylates, is critical when considering this diagnosis. Unfortunately, the neurologic and systemic effects of salicylate toxicity may hinder the ability to obtain a reliable medical history. SIPE should be considered in patients who present with pulmonary edema and neurological changes, anion-gap metabolic acidosis, or possible sepsis. Some patients may be treated for “pseudosepsis” or other conditions, thereby delaying the diagnosis of salicylate intoxication. Misdiagnosis and possibly delayed diagnosis of SIPE can lead to a significant increase in morbidity and mortality. Serum and urine alkalinization by administration of intravenous sodium bicarbonate are commonly utilized therapeutic strategies. Finally, hemodialysis is a therapy which should be considered early in the course of treatment. The objective of this review was to emphasize the importance of rapid diagnosis and appropriate treatment in patients with SIPE, and summarize the current literature as it relates to the adult population.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Granville-Grossman KL, Sergeant HG. Pulmonary oedema due to salicylate intoxication. Lancet 1960;1:575–577.
 
2. Alexander WD, Smith G. Disadvantageous circulatory effects of salicylate in rheumatic fever. Lancet 1962;1:768–771.
 
3. Greenstein SM. Pulmonary edema due to salicylate intoxication: report of a case. Dis Chest 1963;44:552–553.
 
4. Proudfoot AT, Brown SS. Acidaemia and salicylate poisoning in adults. Br Med J 1969;2:547–550.
 
5. Greenbaum DM, Togba J, Blecker J, et al. Salicylate intoxication: an unusual presentation. Chest 1974;66:575–576.
 
6. Hrnicek G, Skelton J, Miller WC. Pulmonary edema and salicylate intoxication. JAMA 1974;230:866–867.
 
7. Tweeddale MG. Salicylate and pulmonary edema. Ann Intern Med 1974;81:710–711.
 
8. Davis PR, Burch RE. Pulmonary edema and salicylate intoxication. Ann Intern Med 1974;80:553–554.
 
9. Tashima CK, Rose M. Pulmonary edema and salicylates. Ann Intern Med 1974;81:274–275.
 
10. Anderson RJ, Potts DE, Gabow PA, et al. Unrecognized adult salicylate intoxication. Ann Intern Med 1976;85:745–748.
 
11. Broderick TW, Reinke RT, Goldman E. Salicylate-induced pulmonary edema. Am J Roentgenol 1976;127:865–866.
 
12. Andersen R, Refstad S. Adult respiratory distress syndrome precipitated by massive salicylate poisoning. Intensive Care Med 1978;4:211–213.
 
13. Sørensen SC. Adult respiratory-distress syndrome in salicylate intoxication. Lancet 1979;1:1025.
 
14. Heffner J, Starkey T, Anthony P. Salicylate-induced noncardiogenic pulmonary edema. West J Med 1979;130:263–266.
 
15. Hormaechea E, Carlson RW, Rogove H, et al. Hypovolemia, pulmonary edema and protein changes in severe salicylate poisoning. Am J Med 1979;66:1046–1050.
 
16. Heffner JE, Sahn SA. Salicylate-induced pulmonary edema. Clinical features and prognosis. Ann Intern Med 1981;95:405–409.
 
17. Liebman RM, Katz HM. Pulmonary edema in a 52-year-old woman ingesting large amounts of aspirin. JAMA 1981;246:2227–2228.
 
18. Zimmerman GA, Clemmer TP. Acute respiratory failure during therapy for salicylate intoxication. Ann Emerg Med 1981;10:104–106.
 
19. Walters JS, Woodring JH, Stelling CB, et al. Salicylate-induced pulmonary edema. Radiology 1983;146:289–293.
 
20. Niehoff JM, Baltatzis PA. Adult respiratory distress syndrome induced by salicylate toxicity. Postgrad Med 1985;78:117–119, 123.
 
21. Suarez M, Krieger BP. Bronchoalveolar lavage in recurrent aspirin-induced adult respiratory distress syndrome. Chest 1986;90:452–453.
 
22. Pei YP, Thompson DA. Severe salicylate intoxication mimicking septic shock. Am J Med1987;82:381–382.
 
23. McGuigan MA. A two-year review of salicylate deaths in Ontario. Arch Intern Med 1987;147:510–512.
 
24. Thisted B, Krantz T, Strøm J, et al. Acute salicylate self-poisoning in 177 consecutive patients treated in ICU. Acta Anaesthesiol Scand 1987;31:312–316.
 
25. Chapman BJ, Proudfoot AT. Adult salicylate poisoning: deaths and outcome in patients with high plasma salicylate concentrations. Q J Med 1989;72:699–707.
 
26. Bailey RB, Jones SR. Chronic salicylate intoxication. A common cause of morbidity in the elderly. J Am Geriatr Soc 1989;37:556–561.
 
27. Stockberger S, Cornelt M. Young woman with headaches and pulmonary edema. Indiana Med 1991;84:122–123.
 
28. Neuzil KM. A case of noncardiogenic pulmonary edema. J Tenn Med Assoc 1991;84:18–9.
 
29. Pond SM, Armstrong JG, Henderson A. Late diagnosis of chronic salicylate intoxication. Lancet 1993;342:687.
 
30. Woolley RJ. Salicylate-induced pulmonary edema: a complication of chronic aspirin therapy. J Am Board Fam Pract 1993;6:399–401.
 
31. Chalasani N, Roman J, Jurado RL. Systemic inflammatory response syndrome caused by chronic salicylate intoxication. South Med J 1996;89:479–482.
 
32. Varela N, Bognar M, Agudelo C, et al. Salicylate toxicity in the older patient. J Clin Rheumatol 1998;4:1–5.
 
33. Gonzolez ER, Cole T, Grimes MM, et al. Recurrent ARDS in a 39-year-old woman with migraine headaches. Chest 1998;114:919–922.
 
34. Chui PT. Anesthesia in a patient with undiagnosed salicylate poisoning presenting as intraabdominal sepsis. J Clin Anesth 1999;11:251–253.
 
35. Grabe DW, Manley HJ, Kim JS, et al. Respiratory distress caused by salicylism confirmed by lung biopsy. Clin Drug Invest 1999;17:79–81.
 
36. Cohen DL, Post J, Ferroggiaro AA, et al. Chronic salicylism resulting in noncardiogenic pulmonary edema requiring hemodialysis. Am J Kidney Dis 2000;36:E20.
 
37. Rauschka H, Aboul-Enein F, Bauer J, et al. Acute cerebral white matter damage in lethal salicylate intoxication. Neurotoxicology 2007;28:33–37.
 
38. Jain MK, Indurkar M, Malviya S, et al. Aspirin-induced non-cardiogenic pulmonary edema. J Assoc Physicians India 2007;55:308.
 
39. Pearlman BL, Gambhir R. Salicylate intoxication: a clinical review. Postgrad Med 2009;121:162–168.
 
40. Gaudreault P, Temple AR, Lovejoy FH Jr. The relative severity of acute versus chronic salicylate poisoning in children: a clinical comparison. Pediatrics 1982;70:566–569.
 
41. Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-the-hospital management. Clin Toxicol (Phila) 2007;45:95–131.
 
42. Kerr F, Krenzelok EP. Salicylates, in Shannon M, Borron SW, Burns M (eds): Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. Philadelphia, Sanders 2007, ed 4, pp 835–848.
 
43. Bowers RE, Brigham KL, Owen PJ. Salicylate pulmonary edema: the mechanism in sheep and review of the clinical literature. Am Rev Resp Dis 1977;115:261–268.
 
44. Flomenbaum NE. Salicylates, in Goldfrank LR, Flomenbaum NE, Lewin NA, et al (eds): Goldfrank's Toxicologic Emergencies. New York, McGraw Hill 2002, ed 7, pp 507–527.
 
45. Leatherman JW, Schmitz PG. Fever, hyperdynamic shock, and multiple-system organ failure. A pseudo-sepsis syndrome associated with chronic salicylate intoxication. Chest 1991;100:1391–1396.
 
46. Galbois A, Ait-Oufella H, Baudel JL, et al. An adult can still die of salicylate poisoning in France in 2008. Intensive Care Med 2009;35:1999.
 
47. Schwarz MI, Albert RK. “Imitators” of ARDS: implications for diagnosis and treatment. Chest 2004;125:1530–1535.
 
48. Vourlekis JS, Brown KK, Cool CD, et al. Acute interstitial pneumonitis: case series and review of the literature. Medicine (Baltimore) 2000;79:369–378.
 
49. Olson J, Colby TV, Elliott CG. Hamman-Rich syndrome revisted. Mayo Clin Proc 1990;65:1538–1548.
 
50. Burke A, Smyth E, FitzGerald GA. Analgesic-antipyretic agents; pharmacotherapy of gout, in Brunton LL, Lazo JS, Parker KL (eds): Goodman and Gillman's The Pharmacologic Basis of Therapeutics. New York, McGraw-Hill, 2006, ed 11, pp 671–715.
 
51. Done AK. Aspirin overdosage: incidence, diagnosis, and management. Pediatrics 1978;62:890–897.
 
52. Greenberg MI, Hendrickson RG, Hofman M. Deleterious effects of endotracheal intubation in salicylate poisoning. Ann Emerg Med 2003;41:583–584.
 
53. Stolbach AI, Hoffman RS, Nelson LS. Mechanical ventilation was associated with acidemia in a case series of salicylate-poisoned patients. Acad Emerg Med 2008;15:866–869.
 
54. Proudfoot AT, Krenzelok EP, Vale JA. Position paper on urine alkalinization. J Toxicol Clin Toxicol 2004;42:1–26.
 
55. Vree TB, Van Ewijk-Beneken Kolmer EW, Verwey-Van Wissen CP, et al. Effect of urinary pH on the pharmacokinetics of salicylic acid, with its glycine and glucuronide conjugates in human. Int J Clin Pharmacol Ther 1994;32:550–558.
 
56. Prescott LF, Balali-Mood M, Critchley JA, et al. Diuresis or urinary alkalinisation for salicylate poisoning? Br Med J (Clin Res Ed) 1982;285:1383–1386.
 
57. Fertel BS, Nelson LS, Goldfarb DS. The underutilization of hemodialysis in patients with salicylate poisoning. Kidney Int 2009;75:1349–1353.
 
58. Yip L, Dart RC, Gabow PA. Concepts and controversies in salicylate toxicology. Emerg Med Clin North Am 1994;12:351–364.