Chronic Salicylate Intoxication in Infants and Children

嬰兒及兒童慢性水楊酸鹽中毒

張慧理(Hui-Li Chang) ； 黃富源(Fu-Yuan Huang) ； 陳銘仁(Ming-Ren Chen) ； Irving J. Olshin

《Acta Paediatrica Sinica》 29卷1期 (1988/02) Pp. 1-7

摘要

自1981年至1986年，共有56例因水楊酸中毒（血清水楊酸值超過20mg/dl）之病患住進馬偕紀念醫院小兒科病房。其中4例屬於急性中毒，52例屬於慢性中毒。
慢性中毒病患中，年齡由21天至13歲不等，平均年齡為一歲兩個月。輕度中毒有7例、中度中毒有28例、重度中毒有17度。在不同程度中毒患者間，血清水楊酸值並未呈有意義之差別。顯示血清水楊酸值不適用於估量嬰幼兒慢性水楊酸中毒的嚴重程度。51例接受動脈血氣體分析測定之患者，皆呈現代謝性酸中毒，其中28例合併有呼吸性鹼中毒。部分慢性水楊酸中毒患者，其血中氨值或肝酵素值有明顯上升現象，因而極不易與雷氏徵候症(Reye's syndrome)區別，故疑似雷氏徵候症患者，又有服用退燒藥之病史時，最好能同時檢驗血清水楊酸值，以排除水楊酸中毒之可能性。52例慢性中毒患者中，有5例死亡，8例智能發育遲鈍。此13例皆有同時罹患嚴重疾病：腦性麻痺5例、雷氏徵候症4例、腦炎2例、綠膿桿菌敗血病1例、心肌病變(cardiomyopathy)1例。放慢性水楊酸中毒之預後，可能與同時罹患疾病之有無與其嚴重程度有關。
水楊酸製劑在臺灣隨處皆可購買。由於其在人體內有非尋常之排除動力態度(elimination kinetics)，我們建議：應讓使用者知道常用之水楊酸製劑－例如口服製劑、針劑或栓劑，以及商品名稱，並告知每天使用之最高劑量。另外，由於水楊酸代謝之快慢，可能因人而異。故亦應提醒使用者水楊酸中毒之可能性及其中毒時可能出現之徵候，俾能早期發現，送醫治療。臨床上對於有發燒、呼吸加快、加深、找不出原因之代謝性酸中毒、昏睡、意識不清、或有抽搐現象之患者，又有服食水楊酸退燒製劑之病史時，應考慮到慢性水楊酸中毒之可能性。

並列摘要

From 1981 to 1986, 54 Patients (with 56 episodes) with salicylate overdosage were admitted to the Pediatric Department of Mackay Memorial Hospital. Serum salicylate levels were greater than 20mg/dl. Four episodes were defined as acute intoxication, and the other 52 as chronic intoxication.
In chronic cases, the ages of patients ranged from 21 days to 13 years, with an average of one year and two months. Seven cases were classified clinically as mild intoxication, 28 moderate, and 17 severe. There was no significant difference in serum salicylate levels among these three clinical groups. Serum salicylate levels proved not to be a useful indicator for estimating the clinical severity of chronic salicylate intoxication in infants and children. Metabolic acidosis was the major disturbance in the chronic cases (51/51), but a combined respiratory alkalosis was found in half of them (28/51). Elevated blood ammonia levels and/or hepatic enzymes were noted in a few cases. There were five deaths and eight, neurologically impaired patients in this series. All of these had associated severe concomitant diseases; 5 with cerebral palsy, 4 with Reye's syndrome, 2 with viral encephalitis, I with pseudomonas sepsis, 1 with cardiomyopathy. The outcome of the chronic salicylate intoxication was probably related to the severity of concomitant diseases.
Because of the unusual elimination kinetics of salicylate from the body, we suggest that parents should be informed of the commonly used preparations and brand names of salicylate, the limit of the total daily dosages of salicylate, and the possibility of salicylate intoxication. For patients with fever, tachypnea, hyperpnea, metabolic acidosis, lethargy, disturbances of consciousness, and/or convulsion, chronic salicylisn should be considered.

並列關鍵字

chronic salicylate intoxication ； serum salicylate level ； Reye's syndrome