Salicylate intoxication may be difficult to recognize in an elderly patient unless there is a high index of suspicion. The symptoms may go unrecognized or be ascribed to another cause.
Historical features:
(1) daily and/or high doses of aspirin or other salicylate (since salicylates are present in many OTC preparations this may go unrecognized)
(2) history of renal insufficiency
Clinical findings:
(1) change in mental status (delirium, dementia, confusion, disorientation, hallucinations, forgetfulness)
(2) dehydration
(3) fever
(4) agitation or lethargy
(5) metabolic acidosis
(6) seizures
(7) easy bruisability or bleeding
(8) unexplained falling
(9) hearing loss or tinnitus
(10) deterioration in hygiene or self-care
(11) new onset of renal dysfunction
The presence of one or more of these findings should prompt screening for salicylate intoxication, especially if there is no other explanation.
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