LAUSR

Salicylamide (o-hydroxybenzamide) is a non-prescription drug with analgesic and antipyretic properties, but it is not a salicylate as it lacks a free carboxyl group. It is marked in combination with paracetamol, acetylsalicylic acid, dextromethorphan and caffeine in a variety of over-the-counter pain and cold remedies. In Switzerland a teething gel containing 80mg salicylamide and 1mg lidocaine hydrochloride per gram (line of 2.5 cm) is available (tube of 25 g). The therapeutic single dose of this gel is age-dependent (64–96mg salicylamide). The product contains also 13mg dexpanthenol per gram, a substance of negligible toxicity, and lidocaine is present in low concentration [1]. However, ingestion of teething gels exhibits the risk of overdose and intoxication in children [2,3]. The aim of the study was to determine the acute toxicity profile of this gel in overdose in toddlers, since available information of salicylamide is limited. Therefore, we performed a retrospective review of acute overdose of a salicylamide containing teething gel in toddlers (<4 years), reported to our National poisons centre between 1997 and 2017 with sufficient evidence of exposure and high causality, on the basis of the methodology described in previous studies [4]. The severity of observed symptoms was graded according to the poisoning severity score (PSS) [5]. Overall, 123 patients, 71 (58%) females, 48 (39%) males and 4 (3%) of unknown gender with a median age of 1.8 years (0.8–3.7 years), were included. No effects were reported in 13 cases (11%), minor symptoms in the majority of cases (n1⁄4 100, 81%), and moderate symptoms in 10 cases (8%). There were no severe cases or fatalities reported. In 86 cases (70%) the ingested amount of gel was estimated and ranged from 6 to 25 g gel (median 18.8 g; 0.7–2.8 g/kg, corresponding to 56–224mg/kg salicylamide). No symptoms occurred after ingestion of 1–2.7 g/kg (median 7 g/kg; 135mg/kg salicylamide), and mild symptoms were observed after ingestion of 0.5–2.8 g/kg (median 1.6 g/kg; 128mg/kg salicylamide). Moderate symptoms occurred after ingestion of 0.8–2.5 g/kg (Table 1). Observed signs and symptoms in the 110 symptomatic patients were as follows: gait disturbance (55%), somnolence (55%), vomiting (35%), muscular hypotonia (18%), drowsiness (15%), dizziness (10%) paleness (8%), sopor (unconsciousness; GCS <10) of short duration (7%), epigastric pain (5%), agitation (4%), nausea (3%), confusion (2%), bradycardia (2%), and tachycardia (2%). All symptoms were of short duration, and resolved spontaneously. In 49%, the latency between the ingestion and the onset of symptoms was known and was reported to be 10–165min (median 30min). The peak concentration of salicylamide is reported to be achieved between 12 and 120min after oral administration, which is compatible with the onset of symptoms [6]. In 47%, the duration of symptoms was known and was reported to range from 5 to 360min (median 120min), which is in accordance to the half-life of 25–72min of salicylamide [6]. Gastrointestinal decontamination consisting of a single