Relationship Between Dose and Apparent Volume of Distribution of Salicylate in Children

Abstract

The apparent volume of distribution (Vd) of salicylate was determined in 11 children, 4 months to 16 years old, who had ingested from about 36 to over 340 mg of salicylic acid (mainly as aspirin) per kilogram of body weight. Vd was calculated from the amount of salicylate in the body at a given time (as determined by the amount of total salicylates excreted in the urine and, where applicable, removed in peritoneal dialysis fluid after that time) and the concentration of salicylate in the plasma at the same time. This method of calculation is ideal for the nonlinearly eliminated salicylic acid and does not require any assumptions with respect to the nature of the pharmacokinetic model for salicylate distribution. The Vd for salicylate in the children ranged from 162 to 345 ml/kg and was larger at the higher doses. Plots of salicylate concentration in plasma versus amount of drug in the body were usually linear for a given patient, showing that Vd remained relatively constant over the time course of elimination of the drug in the patients studied. This indicates that a given plasma salicylate concentration in children who have ingested large doses reflects a larger amount of salicylate in the body than the same plasma concentration in children who ingested smaller doses of the drug. These observations help to rationalize and emphasize the usefulness of the Done nomogram (which involves estimation of the theoretical zero time plasma salicylate concentration by back extrapolation) for assessing the severity of salicylate intoxication.