ArticleJournal of medical toxicology : official journal of the American College of Medical Toxicology2026
Can Albumin Trap Salicylate? An In Vitro Exploration of Salicylate Overdose Scenarios.
Article in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSalicylate toxicity remains a significant cause of morbidity and mortality. At therapeutic levels, most salicylic acid (SA) is albumin-bound, but in overdose, the free fraction rises, driving toxicity. Albumin supplementation has been hypothesized as a strategy to reduce free SA, yet quantitative data are limited.
methodsAn in vitro model was developed to assess albumin's binding capacity for salicylic acid across overdose-relevant concentrations. Solutions of SA (SA30 ≈30 mg/dL, SA50 ≈50 mg/dL, SA100 ≈100 mg/dL, SA120 ≈120 mg/dL) were combined with albumin ranging from 1-8 g/dL, representing subphysiologic to supraphysiologic concentrations. One solution (SA120-A) was prepared at pH 7.0 to evaluate binding in acidic environments. Free SA was quantified in each sample.
resultsIncreasing albumin reduced free salicylate under all conditions. From 1-8 g/dL, free SA decreased by 38.56 mg/dL (95% CI [37.62, 39.49] at SA50, 38.49 mg/dL (95% CI [37.77, 39.20] at SA100, 38.83 mg/dL (95% CI [37.85, 39.81] at SA120 (pH 7.4), and 52.77 mg/dL (95% CI [51.54, 54.01] at SA120 (pH 7.0). Correction of hypoalbuminemia (1-4 g/dL) reduced free SA by 11.33 mg/dL (95% CI [11.14, 11.53] at SA30, 21.07 mg/dL (95% CI [20.19, 21.94] at SA50, 18.40 mg/dL (95% CI [18.12, 18.68] at SA100, 18.27 mg/dL (95% CI [16.93, 19.61] at SA120 (pH 7.4), and 21.40 mg/dL (95% CI [21.00, 21.80] at SA120-A (pH 7.0). Increasing albumin further to 8 g/dL reduced free SA by an additional 17.49 mg/dL (95% CI [17.42, 17.56] at SA50, 20.09 mg/dL (95% CI [19.62, 20.55] at SA100, 20.57 mg/dL (95% CI [20.18, 20.95] at SA120 (pH 7.4), and 31.37 mg/dL (95% CI [30.12, 32.62] at pH 7.0. SA30 fell below quantification beyond 5 g/dL.
conclusionAlbumin addition reduced free salicylate, supporting its potential as a "protein sink" in salicylate toxicity. Further research is needed to determine the clinical relevance and safety of this theoretical intervention.
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