Table 6.
Case reports of the wintergreen oil poisoning.
| Patient | Age * | Hospital | Drug Administration and Formulation ** |
Symptoms of Poisoning | Death/ Recovery *** |
Year of the Event | References |
|---|---|---|---|---|---|---|---|
| male | − | − | accidental ingestion of wintergreen oil as a tea sweetener (30 mL) | − | (D) | 1832 | [104] |
| male | − | − | accidental ingestion of wintergreen oil (60 mL) | diarrhoea, sweating, internal burning, skin intensely red | (D) | 1900 | [105] |
| female | 40Y | − | accidental ingestion of wintergreen oil (30 mL) | burning in the abdomen, extreme nausea, vomiting, diarrhoea, tinnitus | (R) | 1918 | [106] |
| male with severe cough and shortness of breath, former soldier, and alcoholic | 25Y | − | accidental ingestion of wintergreen oil as a soda drink ingredient | vomiting, no history of any convulsion | (D) | 1927 | [107] |
| male infant | 22M | − | accidental ingestion of wintergreen oil | vomiting, tonic seizures | (D) | 1927 | |
| 43 patients: newborns, infants, children | 1M-3.5Y | − | accidental ingestion of wintergreen oil (4–60 mL) | nausea, vomiting, fever, dehydration, electrolyte disturbance, tinnitus, haematologic disturbances, non-cardiogenic pulmonary oedema, seizures, coma | (R)/(D) | 1937–1992 | [50] |
| male child | 2Y3M | − | accidental ingestion of wintergreen oil (30 mL) | burning of the mouth, vomiting, dyspnoea, paleness, dehydration, restlessness, twitching | (D) | 1944 | [108] |
| infant | − | Children’s National Hospital, District of Columbia, USA | accidental ingestion of wintergreen oil | − | (D) | 1948 | [109] |
| female infant with a cold | 25M | Royal Hospital for Sick Children, Edinburgh, Scotland | accidental ingestion of wintergreen oil (less than 15 mL) | vomiting, loose stools, irritability, dyspnoea, paleness, muscle twitching | (D) | 1953 | [100] |
| male child | 2Y | Salt Lake Country General Hospital, Salt Lake City, UT, USA | accidental ingestion of wintergreen oil (20 mL) | vomiting, hyperactivity; serum salicylate concentration (66 mg/100 mL on admission, 86 mg/100 mL after 2 h after admission, 51 mg/100 mL after blood transfusion, 6.7 mg/100 mL after 67 h after admission) | (R) | 1956 | [110] |
| male child | 2Y | St. Francis Hospital, Blue Island, IL, USA | accidental ingestion of wintergreen oil (60 mL) | vomiting, tachypnoea, stupor; serum salicylate concentration (57.9 mg/100 mL after 12 h after admission, 54 mg/100 mL after 28 h after admission) | (R) | 1957 | [111] |
| 84 patients: newborns, infants, children, males, females | 1.2M-88Y | − | oral salicylate ingestion 86%; oral wintergreen oil (methyl salicylate) ingestion 11%; rectal salicylate 1%; topical salicylate 2% | altered consciousness (62%), seizures (11%), vomiting (22%), hyperthermia (43%), hypotension (15%), pulmonary oedema (5%), acute kidney injury (15%), median peak serum salicylate concentration 86 mg/dL (range 35–238 mg/dL) | (R)—88%; (D)—11%; permanent sequelae—1% | 1958–2013 | [112] |
| male child | 3Y2M | Winnipeg Children’s Hospital, Canada | accidental ingestion of wintergreen oil (15 mL) | vomiting, heavy breathing, drowsiness, hyperventilation, dehydration; serum salicylate concentration (69 mg% on admission, 37 mg% after blood transfusion, 32 mg% 9 h after blood transfusion) | (R) | 1960 | [113] |
| male (Indian stoker) with a cold | − | cargo ship in the Red Sea | ingestion of wintergreen oil (60 mL) as a cold medicine | abdominal pain, board-like rigid of abdominal muscles, urticarial rash, itch | (R) | 1968 | [114] |
| three patients (sex unknown) | − | Mackay Memorial Hospital, Taipei, Taiwan | accidental ingestion of wintergreen oil | hyperventilation, high serum level of salicylate | (D)—1 patient; (R)—2 patients | 1974–1976 | [115] |
| female infant | 21M | − | wintergreen oil in the form of candy flavouring | vomiting, lethargy, hyperpnea; serum salicylate concentration (81 mg/dL 6 h after ingestion) | (R) | 1985 | [116] |
| male | 44Y | McLeod Regional Medical Centre, Florence, SC, USA | accidental ingestion of wintergreen oil (30 mL) | seizures, tachypnoea, diarrhoea, confusion, diaphoresis, cardiopulmonary arrest; serum salicylate concentration (78.3 mg/dL on admission) | (D) | 1989 | [117] |
| 24 patients: males and females | 15–86Y | Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China | accidental ingestion (2 patients), suicidal attempt or as self-treatment for a stroke (1 patient), or self-poisoning (21 patients) of/with ‘White Flower Oil’ A (amount ingested: not known—11 patients, ≤10 mL—5 patients, 10–20 mL—2 patients) or ‘Red Flower Oil’ B (amount ingested: not known—2 patients, ≤10 mL—1 patient, 10–20 mL—1 patient, 30–100 mL—2 patients) | ‘White Flower Oil’ A (severity of salicylate poisoning: no symptoms—7 patients, mild—11 patients, moderate–severe—0 patients); ‘Red Flower Oil’ B (severity of salicylate poisoning: no symptoms—0 patients, soft—3 patients, moderate–severe—3 patients); serum salicylate concentration: ‘White Flower Oil’ A (0.1–1.0 mM/L—12 patients, 1.1–2.1 mM/L—5 patients, ≥2.2 mM/L—1 patient); ‘Red Flower Oil’ B (0.1–1.0—2 patients, 1.1–2.1 mM/L—0 patient, ≥2.2 mM/L—4 patients) | ‘White Flower Oil’ A: (R)—18 patients, (D)—0 patients; ‘Red Flower Oil’ B: (R)—5 patients, (D)—1 patient | 1991–1998 | [118] |
| female with hypertension and arthritis | 70Y | The Poison Control Center Children Hospital of Philadelphia, Pennsylvania; Cooper Hospital/University Medical Center-UMDNJ/RWJ Camden, New York; Shore Memorial Hospital Somers Point, New York, USA | ingestion of Koong Yick Huang FA Oil® (60 mL; containing 67% wintergreen oil) in an attempt to relieve chronic knee pain | abdominal pain, restlessness, diaphoresis, tachycardia, seizures, metabolic acidosis; serum salicylate concentration (108.6 mg/dL on admission) | (D) | 1998 | [102] |
| female infant | 18M | Great Ormond Street Hospital, London, UK | accidental ingestion of wintergreen oil | nausea, vomiting, irritability, lethargy, tachypnoea; serum salicylate concentration (4.8 mmol/L on admission) | (R) | 2001 | [97] |
| male | 40Y | Royal Prince Alfred Hospital Emergency Department, Sydney, Australia | wintergreen oil applied topically by an unregistered Chinese herbalist | vomiting, tinnitus, dizziness, erythema, sweating; serum salicylate concentration (48.5 mg/dL 36 h after ingestion) | (R) | 2002 | [96] |
| female | 29Y | National Poisons Information Service, Birmingham; Edinburgh; Cardiff; Newcastle, UK | intentional ingestion of wintergreen oil (60 mL) with alcohol in a suicide attempt | cardiac arrest for 30 min; serum salicylate concentration (1196 mg/L 4 h after ingestion) | (D) | 2003–2022 | [119] |
| male | 25Y | intentional ingestion of wintergreen oil (15 mL) over a 2 h period with alcohol (suicide attempt); intentional ingestion of wintergreen oil (15 mL) after 5 days |
serum salicylate concentration (639 mg/L 2.5 h after ingestion); serum salicylate concentration (1150 mg/L 6.5 h after ingestion) |
(R) | |||
| patient (sex unknown) | − | intentional ingestion of wintergreen oil (35 mL) in a suicide attempt | serum salicylate concentration (629 mg/L at unknown time post-ingestion) | − | |||
| patient (sex unknown) | − | intentional ingestion of wintergreen oil in a suicide attempt | serum salicylate concentration (661 mg/L 6 h after ingestion) | − | |||
| female | 79Y | Tondabayashi Hospital, Osaka, Japan | Teipap A Cool® compress (Teikoku Seiyaku Co., Ltd., Kagawa, Japan) soaked with wintergreen oil | rectangular pruritic, erythematous macule on the hip | (R) | 2004 | [120] |
| male with diabetes mellitus, nephropathy, and coronary artery disease | 80Y | San Francisco General Hospital, San Francisco, USA | accidental ingestion of wintergreen oil (mouthful volume ≈ 21 mL) | vomiting, tonic-clonic seizure, unresponsiveness, apnoea; serum salicylate concentration (74.8 mg/dL after dialysis, 82.6 mg/dL post-mortem) | (D) | 2007 | [121] |
| male infant | 16M | Hospital Kulim, Kulim, Kedah, Malaysia | accidental ingestion of wintergreen oil as a massage oil | vomiting, tonic-clonic seizure, dehydration, hypotonia; serum salicylate concentration (112.15 mg/L on admission) | (R) | 2012 | [122] |
| male | 32Y | National Hospital of Sri Lanka, Sri Lanka | accidental ingestion of wintergreen oil | sudden syncopal attack, tonic-clonic seizure, cardiac arrest | (D) | 2015 | [123] |
| male | 42Y | National Hospital of Sri Lanka, Sri Lanka | accidental ingestion of wintergreen oil (10 mL) | vomiting, burning epigastric pain, anxiety, restlessness, tachypnoea, metabolic acidosis and respiratory alkalosis, tonic-clonic seizure | (R) | 2015 | |
| female with hypertension, asthma, and ischaemic cerebral stroke | 77Y | Ewha Womans University Mokdong Hospital, Seoul, Korea | accidental ingestion of topical liniment (Mentholatum® containing wintergreen oil) | hyperthermia, tachypnoea, metabolic acidosis; serum salicylate concentration (320 mg/L one day after admission) | (R) | 2016 | [124] |
| male child (12.6 kg) | 2Y | Emergency Medicine Unit, The University of the West Indies, St. Augustine, Trinidad and Tobago | accidental ingestion of wintergreen oil | five episodes of vomiting, tremors, tachycardia, tachypnoea, tonic-clonic seizures, cardiac arrest | (R) | 2016 | [125] |
| female with hands, forearms, legs, and face dermatitis for the last two months | 45Y | − | R.C.TM essential oil blend (containing wintergreen oil) as aromatherapy for pain relief | erythema, itchy plaques, papules, and vesicles in the areas mentioned above | (R) | 2020 | [126] |
| female (43 kg weight) with depression, atrial fibrillation, and sleep apnoea | 74Y | Utah Poison Control Centre, Salt Lake City, UT, USA | two cups of EcoLogicTM Home Insect Control insecticide (containing wintergreen oil) in a suicide attempt | abdominal pain, vomiting, difficulty in hearing, tinnitus, tachypnoea; serum salicylate concentration (72.5 mg/dL 2 h after ingestion, 59 mg/dL at 6 h, 39.3 ng/dL at 18 h, 22.8 mg/dL at 30 h, 17 mg/dL at 38 h) | (R) | 2020 | [127] |
| male | 67Y | Bordeaux University Hospital, Bordeaux, France | French green clay (Cattier, Paris, France; containing 10% wintergreen oil) topically once a day for three days as a leave-on product | a 3-week history of erythema and bullous lesions on the right knee | (R) | 2022 | [128] |
| male with diabetes mellitus for the past 10 years | 58Y | Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India | accidental ingestion of wintergreen oil (5–6 mL) | giddiness, uneasiness, restlessness, tachycardia, tachypnoea, metabolic acidosis, respiratory alkalosis, hypotension | (R) | 2022 | [129] |
* age in months (M) or years (Y); ** wintergreen oil (containing min. 98% methyl salicylate); *** death (D) or recovery (R); A ‘White Flower Oil’ (containing 40% of methyl salicylate); B ‘Red Flower Oil’ (containing 30–67% of methyl salicylate, depending on the product brand).