How is the test used?This test is used to detect a high level of salicylate in the blood. It may be used to: Show
When is it ordered?Salicylate testing may be ordered when it is suspected you have ingested a large amount of aspirin or other drugs containing salicylate. Usually, blood is drawn and tested at least 4 hours after last known ingestion. Results from tests done earlier than this are difficult to interpret. Testing may be ordered when you have symptoms associated with an acute or chronic salicylate overdose. Typically, these symptoms will appear 3 to 8 hours after initial ingestion in cases of acute toxicity and may include:
Additional symptoms that may develop include:
Testing may be done when people are suspected of wanting to harm themselves (suicidal tendencies). When acute salicylate toxicity is detected, a healthcare practitioner may order the test as frequently as every 2 to 3 hours to monitor the resolution of the overdose. Salicylate levels will continue to be monitored until there are two consecutive results that show a decrease from peak levels. Clinical signs of salicylate poisoning/toxicity will also be monitored frequently. When you take regular doses of a prescribed salicylate, your healthcare practitioner may order this test on a routine basis to check for an elevated level since chronic toxicity may develop without obvious signs and symptoms, or with symptoms that develop slowly and are nonspecific (i.e., may be seen with many other conditions). What does the test result mean?Normal therapeutic blood concentrations of aspirin and other salicylates depend upon what the drug is being used for, and blood levels must be interpreted along with your medical history and clinical signs and symptoms. Lower blood levels are sufficient for pain relief and to lower risk of blood clots, but higher levels may be required for managing inflammation in rheumatic conditions such as arthritis. At these higher levels, some side effects may become apparent. The severity of signs and symptoms, and at what dose they appear, depends upon the individual. Symptoms may be seen with blood levels that are generally considered to be therapeutic in inflammatory conditions, and they will tend to appear in many people at levels of about 10-30 mg/dL. This is especially true in patients who may have kidney or liver disease. In general, the severity of salicylate toxicity increases with increasing concentrations. The table below summarizes some results that may be seen. These numbers typically represent a blood sample that is collected at least 4 hours after last dose:
Note: Some laboratories report salicylates as milligrams per deciliter (mg/dL) while others report micrograms per milliliter (mcg/mL). These two are different by a factor of 10. Rising levels (when you have not taken more salicylate) indicate that peak salicylate concentrations have not yet been reached. In an otherwise healthy person, peak salicylate levels occur 2 hours after ingestion. However, in cases of a large ingestion of pills or tablets, hard, solid masses (concretions or bezoars) can form, delaying the peak by six hours or more. A delay in peak levels can also occur if the person ingested "enteric" or "sustained-release" forms of salicylate. Falling salicylate levels tend to indicate that the excess is being eliminated by the body and that the overdose is resolving. This is confirmed by two decreasing levels of salicylate once peak concentration has been reached. What other tests might be ordered in emergency or overdose cases?In emergency situations, a salicylate test may be ordered with other tests, such as:
Is there anything else I should know?Be aware that many prescription and nonprescription medications contain salicylates in combination with other medications. Do not take more than one medication that contains salicylates at a time. Aspirin should not be taken long-term without consulting a healthcare practitioner and should NEVER be given to children or teens unless directed by a healthcare provider. Aspirin should not be taken with alcoholic drinks as this can increase the risk of bleeding from the stomach. If aspirin overdose is suspected, seek medical attention for the affected person. Salicylates, including aspirin, are included in the group of drugs called NSAIDs (nonsteroidal anti-inflammatory drugs). People with asthma and nasal polyps may be hypersensitive to salicylates and other NSAIDs. In addition, use of NSAIDs is not recommended in people with kidney or liver disease, bleeding disorders, other salicylate-containing drugs, and women who are pregnant or breast-feeding. A breakdown of muscle tissue (rhabdomyolysis) may sometimes occur as a complication of salicylate poisoning. I’ve heard of Trinder's test for salicylates. What is it?Trinder's test is a screening test that may be used to screen for the presence of salicylate in urine. If the test is positive, this may prompt the healthcare practitioner to test for presence of salicylate in the blood. Should everyone who takes aspirin regularly have a salicylate test performed?If you take occasional doses for pain, take only one low-dose tablet a day, or take moderate amounts of aspirin under the supervision of your healthcare provider and do not experience any side effects, then it is not typically necessary. Most people will not need to have this test performed unless they accidentally ingest significant quantities of aspirin or another salicylate, or if they develop side effects. Will taking aspirin at normal dosage cause complications?Occasional use of aspirin for pain relief at recommended doses usually does not cause complications. It is possible that taking aspirin regularly at higher doses used to treat rheumatoid arthritis, for example, may cause symptoms and other complications, such as an increased risk of bleeding. You should only take aspirin on a regular basis (e.g., daily) under the supervision of a healthcare practitioner. Low-dose aspirin used to reduce the risk of heart attack is generally safe, but even this use should be discussed with a healthcare practitioner. I am on a low-dose aspirin regimen to prevent another heart attack. Do I need to be monitored with salicylate tests?No, usually you will not need to be monitored with a salicylate test since the risk of toxicity is low. However, you may be tested to determine whether the treatment to lower your risk of heart attack has been effective using a test that measures platelet function. Aspirin works to prevent blood clots and heart attacks by inhibiting platelet activation and/or clumping (aggregation). Platelet function tests are sometimes used to monitor anti-platelet therapy, including aspirin. For more on this, see the article on Platelet Function Tests. Why should aspirin not be given to children?An association has been found between the use of aspirin to treat the symptoms of flu-like viral illnesses such as the chickenpox and the development of Reye syndrome, a disease marked by acute brain damage and liver dysfunction that can be fatal. Aspirin should never be given to children unless directed by a healthcare practitioner. The National Reye's Syndrome Foundation, the U.S. Surgeon General, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics all recommend against the use of aspirin or other products containing aspirin to treat fever-causing illnesses in children under the age of 19 years. How is a salicylate overdose treated?Anyone who is showing signs of salicylate poisoning should be taken to the emergency room. There is no antidote available for this type of overdose, so treatment is aimed at slowing and/or stopping further absorption of the drug while increasing elimination from the body. The type and extent of treatment is based on the severity of the poisoning.
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A person who ingests an excessive amount of salicylate would most likely experience:
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