“I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations

Introduction: Salicylate poisoning remains one of the most common global accidental overdoses and poses a considerable health threat. Typical presentations for salicylate overdoses include nausea, vomiting, and abdominal pain as well as tinnitus, tachypnea, fever, and dehydration resulting in a conc...

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Main Authors: Jessica Meyers, Sean McCormick, Phillip D. Levy, Michael J. Twiner
Format: Article
Language:English
Published: eScholarship Publishing, University of California 2025-01-01
Series:Clinical Practice and Cases in Emergency Medicine
Online Access:https://escholarship.org/uc/item/3x88t72f
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author Jessica Meyers
Sean McCormick
Phillip D. Levy
Michael J. Twiner
author_facet Jessica Meyers
Sean McCormick
Phillip D. Levy
Michael J. Twiner
author_sort Jessica Meyers
collection DOAJ
description Introduction: Salicylate poisoning remains one of the most common global accidental overdoses and poses a considerable health threat. Typical presentations for salicylate overdoses include nausea, vomiting, and abdominal pain as well as tinnitus, tachypnea, fever, and dehydration resulting in a concomitant metabolic acidosis and respiratory alkalosis. This may progress to a predominance of neurological symptoms such as mental status changes, confusion, delirium, and hallucinations. Case Report: We describe the case of an accidental, sub-chronic overdose (up to 7.5 grams/day for multiple weeks; ~75 milligrams/kilogram/day) that resulted in predominantly neurological symptoms (ie, tinnitus and hallucinations, including the patient reporting “seeing dead people”) but without the more typical findings classically associated with salicylate toxicity. The patient was started on a sodium bicarbonate drip; after two days, symptoms completely resolved, and she was safely discharged home. Conclusion: This case serves as a reminder for physicians to have a high index of suspicion for chronic toxicities including salicylates in patients who present as acute psychosis or altered mental status of unknown etiology.
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spelling doaj-art-a9085ac88ee544a3a8c1aabcfba1ca9e2025-02-04T17:35:19ZengeScholarship Publishing, University of CaliforniaClinical Practice and Cases in Emergency Medicine2474-252X2025-01-0191828510.5811/cpcem.33609cpcem-9-82“I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with HallucinationsJessica Meyers0Sean McCormick1Phillip D. Levy2Michael J. Twiner3Wayne State University, Department of Emergency Medicine, Detroit, MichiganWayne State University, Department of Emergency Medicine, Detroit, MichiganWayne State University, Department of Emergency Medicine, Detroit, MichiganWayne State University, Department of Emergency Medicine, Detroit, MichiganIntroduction: Salicylate poisoning remains one of the most common global accidental overdoses and poses a considerable health threat. Typical presentations for salicylate overdoses include nausea, vomiting, and abdominal pain as well as tinnitus, tachypnea, fever, and dehydration resulting in a concomitant metabolic acidosis and respiratory alkalosis. This may progress to a predominance of neurological symptoms such as mental status changes, confusion, delirium, and hallucinations. Case Report: We describe the case of an accidental, sub-chronic overdose (up to 7.5 grams/day for multiple weeks; ~75 milligrams/kilogram/day) that resulted in predominantly neurological symptoms (ie, tinnitus and hallucinations, including the patient reporting “seeing dead people”) but without the more typical findings classically associated with salicylate toxicity. The patient was started on a sodium bicarbonate drip; after two days, symptoms completely resolved, and she was safely discharged home. Conclusion: This case serves as a reminder for physicians to have a high index of suspicion for chronic toxicities including salicylates in patients who present as acute psychosis or altered mental status of unknown etiology.https://escholarship.org/uc/item/3x88t72f
spellingShingle Jessica Meyers
Sean McCormick
Phillip D. Levy
Michael J. Twiner
“I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations
Clinical Practice and Cases in Emergency Medicine
title “I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations
title_full “I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations
title_fullStr “I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations
title_full_unstemmed “I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations
title_short “I’m Seeing Dead People”: A Case Report on Salicylate Poisoning in a Patient with Hallucinations
title_sort i m seeing dead people a case report on salicylate poisoning in a patient with hallucinations
url https://escholarship.org/uc/item/3x88t72f
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