title: Systemic inflammatory response syndrome caused by chronic salicylate intoxication.
abstract: Systemic inflammatory response syndrome (SIRS) is characterized by body temperature abnormalities, tachypnea or hyperventilation, tachycardia, and leukocytosis or leukopenia. Although it is typically associated with a serious infection and referred to as sepsis, SIRS can stem from noninfectious causes, as well. We report the cases of four patients with toxic serum levels of salicylate (33.5 to 67.6 mg/dL) and SIRS, and we discuss mechanisms responsible for SIRS. Our patients showed temperature disturbances (35.5 degrees C to 39.8 degrees C), noncardiogenic pulmonary edema, and mixed acid base disturbances. Other abnormalities included coagulopathy (disseminated intravascular coagulation), encephalopathy, and hypotension. All four patients recovered from SIRS, probably due to early recognition and treatment; only one patient did not survive the hospitalization. Chronic salicylate toxicity should be considered as a cause of SIRS in the absence of a source of infection, since survival appears to be dependent on prompt diagnosis and management.
authors.affiliation: Department of Medicine, Atlanta Department of Veterans Affairs Medical Center, GA 30033, USA.
authors.forename: N
authors.initials: N
authors.lastname: Chalasani
authors.forename: J
authors.initials: J
authors.lastname: Roman
authors.forename: R L
authors.initials: RL
authors.lastname: Jurado
mesh_terms: D000137:Acid-Base Imbalance / Q000503:physiopathology; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000097:blood / Q000506:poisoning*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000097:blood / Q000506:poisoning*; D001241:Aspirin / Q000506:poisoning; D002908:Chronic Disease; D004211:Disseminated Intravascular Coagulation / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000503:physiopathology; D012459:Salicylates / Q000097:blood / Q000506:poisoning*; D020156:Salicylic Acid; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D012459:Salicylates; D020156:Salicylic Acid; D001241:Aspirin; C014182:salicylsalicylic acid