Determinants of low serum concentrations of salicylates in patients with Kawasaki disease

Gideon Koren, Fred Schaffer, Earl Silverman, Scott Walker, Claran Duffy, Leonard Stein, David Suria, Suzan Schue, Jake J. Thiessen, Erwin Gelfand, Ronald Laxer

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28 Scopus citations


The mechanisms leading to the previously reported difficulties in achieving therapeutic serum concentrations of salicylates, in Kawasaki disease were studied in eight children, once during the acute (febrile) phase and again during the nonfebrile (subacute) phase of the disease. Salicylate bloavailability was impaired during the acute phase of the disease (47.7%±6.6%), and increased significantly thereafter to 75.1%±9.3%. During the febrile phase there was a significant correlation between salicylate bioavailability and steady-state serum concentrations. Salicylate renal clearance was significantly higher during the febrile phase (14.45±2.5 mL/kg · h), compared with the nonfebrile phase (7±1.6 mL/kg · h, P<0.05). The change in salicylate clearance could be explained by decreased protein binding in the acute phase (82.5%±1.9%) with substantially more free salicylates caused by significantly lower serum albumin concentrations. Changes in urine metabolites during the acute and subacute phases were consistent with the changes in dose administered (100 mg/kg in the acute phase vs 10 mg/kg in the subacute phase). The pattern of metabolites excreted in the urine of children with Kawasaki disease receiving 100 mg/kg was similar to that in children with juvenile rheumatoid arthritis receiving the same dose.

Original languageEnglish
Pages (from-to)663-667
Number of pages5
JournalJournal of Pediatrics
Issue number4
StatePublished - Apr 1988
Externally publishedYes


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