title: Difficulty in achieving therapeutic serum concentrations of salicylate in Kawasaki disease.
abstract: We investigated 49 children (33 boys), mean (+/- SD) age 2.6 +/- 1.8 years (range 8 months to 8 years), who had Kawasaki disease treated with acetylsalicylic acid (ASA) 30 to 180 mg/kg. There was good correlation between salicylate doses and serum concentrations (r = 0.69, P less than 0.01); however, large variability existed. With doses less than 80 mg/kg/day there was not a single therapeutic salicylate serum concentration (greater than 20 mg/dl). In children receiving 100 to 110 mg/kg/day 55% of the serum concentrations were subtherapeutic. The same pattern persisted with doses greater than 120 mg/kg/day; however, 28% of levels were in the toxic range (greater than 30 mg/dl). There was no evidence of salicylate poisoning in the group; three children receiving greater than 100 mg/kg/day had aspirin-induced gastritis. An additional four children, studied prospectively, received ASA 80 to 180 mg/kg/day. The fraction absorbed was 14% to 60%, which may be compared to a normal 85% to 90% absorption. Salicylate renal clearance in these children (7.3 to 21 ml/kg/hr) was lower than in hyperthermic children. Their steady-state serum salicylate concentrations were subtherapeutic (7 to 11.5 mg/dl). The high ASA dose needed to overcome the impaired absorption should be accompanied by frequent monitoring of levels because of the unpredictable changes in absorption.
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood* / Q000188:drug therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D012459:Salicylates / Q000097:blood*; D020156:Salicylic Acid
chemical_list: D012459:Salicylates; D020156:Salicylic Acid; D001241:Aspirin