International Journal of Pediatric Otorhinolaryngology
Laryngeal oedema caused by accidental ingestion of Oil of Wintergreen☆
Introduction
Childhood poisonings are usually associated with the accidental ingestion of household products or prescribed medication that has serious effects when taken by an infant or child [1].
Methyl salicylate (Oil of Wintergreen) is widely available over the counter as a topical ointment or medicated oil for the relief of musculoskeletal aches and pains (Fig. 1). Oil of Wintergreen is also used to flavour confectionery [2].
Salicylate poisoning due to Oil of Wintergreen ingestion is rare. The earliest cases on record are found in the 1832 edition of Beck's Elements of Medical Jurisprudence [3]. The ingestion of 30 ml can be a lethal dose and even as little as 6 ml has been fatal in adults. As little as 4 ml in a child may be a fatal dose [2].
Oil of Wintergreen's concentrated form, liquid consistency and high lipid solubility pose the threat of severe, rapid-onset salicylate poisoning. The toxic potential of topical medications containing methylsalicylate should be fully appreciated by both physicians and the general public.
Section snippets
Case report
An 18 month old girl presented to the accident and emergency department of her local hospital approximately 12 h following accidental ingestion of Oil of Wintergreen. Initially she had been well, but started vomiting a few hours post ingestion. She was irritable, lethargic and tachypnoeic on examination.
The salicylate level on admission was 4.8 mmol/l. Initial blood gas analysis showed a pH of 7.34, PaCO2 of 2.5, O2 of 12 and base deficit of −12.7. Blood chemistry was normal. After advice had
Discussion
Methyl salicylate or Oil of Wintergreen is an important cause of salicylate poisoning in many western countries and has an appreciable morbidity and mortality [4]. This is largely due to the ready availability of a wide range of topical preparations eg. ‘Extra strength arthritis rub’ and medicated oils eg. ‘Hung far oil’ used for self-treatment of musculoskeletal pain and the common cold, respectively [5]. The pleasant smell of Oil of Wintergreen makes it very attractive to children [2].
Conclusion
Methyl salicylate (Oil of Wintergreen) is widely available over the counter as a topical ointment or medicated oil for the relief of musculoskeletal aches and pains. Oil of Wintergreen is also used as a flavourant in confectionery making. Ingestion of as little as 4 ml could be fatal to a child and this should be fully appreciated by both physicians and the general public.
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Cited by (22)
Updates in the general approach to the pediatric poisoned patient
2013, Pediatric Clinics of North AmericaCitation Excerpt :Five milliliters of the oil contains 7 g of salicylate. Ingestion of as little as 4 mL can be fatal for an infant (<10 kg).62 All salicylate intoxications have similar manifestations; their management is similar as well.
Methyl salicylate
2007, xPharm: The Comprehensive Pharmacology ReferenceSalicylates
2007, Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, Fourth EditionAre one or two dangerous? Methyl salicylate exposure in toddlers
2007, Journal of Emergency MedicineCitation Excerpt :After oral ingestion, methyl salicylate is readily metabolized to salicylic acid. As such, the clinical features of methyl salicylate poisoning are identical to those observed after poisoning with other salicylates (18). Salicylate toxicity is dependent upon the ingested formulation and dosage, patient age, and the acuity of ingestion, with those at the extremes of age and with chronic intoxications at greatest risk.
Salicylism and herbal medicine [1]
2003, American Journal of Emergency Medicine
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Presented at British Association of Paediatric Otolaryngologists, Southampton, UK, October 2000.