To detect salicylate overdose, to help evaluate its severity and monitor its resolution; sometimes to monitor for an overdose if you regularly use prescription-strength salicylates
Salicylates
Salicylates
Also Known As
Aspirin
ASA
Acetylsalicylic acid
Bismuth subsalicylate
Methyl salicylate
Sodium salicylate
Salsalate
Magnesium salicylate
[Often referred to by brand name (see MedlinePlus Drug Information)]
Formal Name
Salicylates, blood, urine
This article was last reviewed
on
This article waslast modified
on
May 27, 2018.
At a Glance
Why Get Tested?
When To Get Tested?
When you have symptoms such as nausea, hyperventilation, ringing in the ears (tinnitus), or confusion that may be from taking too much aspirin or medications with salicylate ingredients; when it is suspected that an unconscious person or a child may have ingested a significant quantity of a salicylate, often as part of emergency and overdose testing; at regular intervals when monitoring an overdose; sometimes on a regular basis if you take a prescription salicylate for rheumatoid arthritis or other autoimmune disorder
Sample Required?
A blood sample drawn from a vein in your arm and/or a urine sample collected in a clean container
Test Preparation Needed?
None, but a healthcare practitioner may ask when you last took a salicylate and the amount taken. If you regularly take a prescription salicylate, the healthcare practitioner may want to collect blood just prior to your next dose (trough level). Tell your healthcare provider about any other medications you are taking.
Accordion Title
Common Questions
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How is it used?
This test is used to detect a high level of salicylate in the blood. It may be used to help diagnose an overdose (salicylate poisoning) or to monitor a person who takes a prescription-strength salicylate. The salicylate screening test may be used to screen for the presence of salicylate in urine.
If a person presents with symptoms that suggest aspirin or other salicylate poisoning, then a salicylate test may be ordered to help detect an overdose. If a healthcare practitioner is not sure what substance(s) a person may have ingested, then a salicylate test may be ordered along with other tests associated with emergency and overdose drug testing. The specific tests ordered will depend upon the person's symptoms and clinical signs.
In emergency situations, a salicylate test may be ordered with other tests, such as:
- Arterial blood gases and electrolytes to evaluate oxygenation and acid-base balance
- Blood urea nitrogen (BUN) and creatinine to evaluate kidney function
- Urinalysis to monitor urine pH
- Glucose to detect low blood sugar
- Liver panel to evaluate liver function
- Coagulation profile (PT, PTT, platelet count)
If a toxic concentration of salicylate is detected, then a series of salicylate tests (and some of the additional tests) may be ordered to determine whether the salicylate level has increased, or has peaked and started to drop. This information is used to help monitor the person's health status and help guide treatment.
A salicylate test may be used to monitor for an overdose if an individual takes regular prescribed doses of salicylate, such as to relieve the symptoms of rheumatoid arthritis, osteoarthritis, or lupus, or to treat rheumatic fever or Kawasaki disease. This may be especially appropriate if the person's other medications, or health status, have changed.
Monitoring is usually not necessary for individuals taking low-dose aspirin to lower the risk of blood clots (thrombosis), heart attack, or stroke (see Common Questions #3).
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When is it ordered?
Salicylate testing may be ordered when it is suspected that someone has 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 a person is experiencing symptoms associated with an acute or chronic salicylate overdose. Symptoms may include:
- Nausea and vomiting
- Hyperventilation (rapid breathing); less common in children
- Ringing in the ears (tinnitus)
- Sweating
- Dizziness
- Confusion
Additional symptoms that may develop include:
- Headache
- Agitation
- Convulsions
- Hallucinations
- Rapid heart rate
- Lethargy
- Coma
- Deafness
- Overheating (hyperthermia), especially in young children with severe toxicity
- Shortness of breath due to fluid accumulation in the lungs (pulmonary edema)
- Bleeding (rare)
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 2-3 hours to monitor the resolution of the overdose.
When an individual is taking regular doses of a prescribed salicylate, a healthcare practitioner may order this test on a routine basis to check for an elevated level since toxicity may develop without obvious signs and symptoms. Someone with chronic salicylate toxicity may have symptoms that develop slowly and are nonspecific, such as confusion, nausea, rapid heart rate, and fever, and these may be seen with many other conditions. A salicylate test may be done to help determine whether salicylate toxicity is the cause of the symptoms.
When salicylate is not prescribed, then identifying chronic salicylate toxicity can sometimes be more challenging. After questioning a patient, a healthcare practitioner may order a salicylate level as part of a number of tests to help determine the cause of the person's symptoms.
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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 in conjunction with a person's 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 emerge, 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. 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:
Salicylate result reported as mg/dL Salicylate result reported as mcg/mL Result Interpretation 2-10 20-100 Therapeutic level for pain relief (analgesia) 10-30 100-300 Anti-inflammatory level; some symptoms of toxicity may appear, such as headache, tinnitus, vertigo Greater than 30 Greater than 300 Considered toxic 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 a person has not taken more salicylate) indicate that peak salicylate concentrations have not yet been reached. Falling salicylate levels tend to indicate that the excess is being eliminated by the body and that the overdose is resolving.
Salicylate toxicity is a serious condition that often requires hospitalization and careful monitoring. In severe cases, the acid-base imbalance that it causes can worsen over time, moving from respiratory alkalosis to metabolic acidosis depending on the period it was ingested, causing electrolyte imbalances, low blood glucose, and dehydration, and proceeding to convulsions, hallucinations, delirium, and coma.
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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.
With large doses of salicylate, accumulations of the tablets (concretions, bezoars) may form in the digestive tract. This can cause the drug to continue to be absorbed for some time, increasing blood levels even though the person has not ingested more of the drug.
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).
A breakdown of muscle tissue (rhabdomyolysis) may sometimes occur as a complication of salicylate poisoning.
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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.
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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 the doses used to treat rheumatoid arthritis, for example, may cause symptoms and may cause complications such as an increased risk of bleeding. Regular aspirin consumption should only be adopted 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.
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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.
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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 characterized 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.
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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 inhibiting further absorption of the drug while increasing elimination from the body. The type and extent of treatment is based on the severity of toxicity. If it is established that an overdose occurred and if it is suspected that some of the drug is still in the stomach, the patient may be given activated charcoal (sometimes several doses), which absorbs any residual drug and prevents it from being absorbed into the body. The patient may also be given bicarbonate to correct acid-base and electrolyte imbalances. A solution containing bicarbonate might be given intravenously (IV) to increase elimination of the drug via the urine. Other medicines may be given to help treat symptoms. In severe cases, dialysis may be performed to remove the drug from the blood.