Salicylism in the elderly: “A little aspirin never hurt anybody!”: Your patients may think that aspirin is completely safe. Do you?

Abstract

Mrs. F. was an 85 year old who not only read widely but also prepared book reports and programs for a variety of local groups. Her only health problems were hypertension and severe osteoporosis with kyphosis. The previous summer she had broken her left hip, had a prosthesis inserted, and moved into the retirement home in her community. After 7 months, Mrs. F. arranged for daytime help and sitters for the night and moved back into her house. Four months later she had a lumbar compression fracture and began to self-treat the pain with 500 mg aspirin with calcium carbonate, magnesium oxide, and magnesium carbonate (Extra Strength Bufferin). She had had several fractures in the past that she had successfully treated with aspirin. This time, however, about 2 months after beginning the self-treatment, she began to have difficulty hearing, and this loss of hearing was interpreted as being the cause for her occasional confused responses. Her physician had a small amount of wax removed from her ears and substituted choline magnesium trisalicylate (Trilisate) tablets for the buffered aspirin. Mrs. F. did not consider the Trilisate tablets effective, so she began taking the buffered aspirin tablets again. Over the next 7 days her condition deteriorated. Her mental confusion was now obvious, and she was experiencing hallucinations. Her physician insisted on an immediate computed axial tomographic (CAT) scan. Mrs. F. had to be transported by ambulance to a hospital in another town for the CAT scan. Her symptoms included confusion, rapid respirations and heart rate, diaphoresis, severe hand tremors, anorexia, and lethargy. It was at this point that salicylism was first suspected, and her use of the buffered aspirin was discontinued. Unfortunately, no blood work was done to test for salicylate intoxication.