Chronic salicylate poisoning is a type of toxic ingestion of salicylate or, rarely, absorption of salicylate from topical application. Acetylsalicylic acid (aspirin) is the most common salicylate, but there are other associated medications including salicylic acid (wart removers), methyl salicylate (oil of wintergreen), and bismuth subsalicylate (Pepto-Bismol). Salicylate is also found in some foods, herbal supplements, and topical ointments. Chronic toxicity occurs due to repeated overuse for several days, which is typically inadvertent.

The elderly population and young children are particularly at risk for chronic salicylate poisoning. Chronic use of aspirin has declined in the pediatric population due to risk of Reye syndrome. In elderly persons, diminished body mass, concurrent administration of drugs, and conditions that exacerbate renal insufficiency may predispose to salicylate intoxication; however, few specific precipitants of chronic salicylism are recognized. Salicylate intoxication should be considered in all elderly patients with delirium and/or dementia.

Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction, or cardiac failure. Salicylate intoxication should be considered when an older patient presents with deterioration in activities of daily living with no known cause.

Related topic: acute salicylate poisoning