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Year : 2013  |  Volume : 5  |  Issue : 5  |  Page : 330

White willow bark induced acute respiratory distress syndrome

1 Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA
2 Department of Pulmonary Medicine, Bassett Medical Center, Cooperstown, New York, USA

Date of Web Publication27-May-2013

Correspondence Address:
Wisit Cheungpasitporn
Department of Medicine, Bassett Medical Center, Cooperstown, New York
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1947-2714.112483

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How to cite this article:
Srivali N, Cheungpasitporn W, Chongnarungsin D, Edmonds LC. White willow bark induced acute respiratory distress syndrome. North Am J Med Sci 2013;5:330

How to cite this URL:
Srivali N, Cheungpasitporn W, Chongnarungsin D, Edmonds LC. White willow bark induced acute respiratory distress syndrome. North Am J Med Sci [serial online] 2013 [cited 2023 Mar 31];5:330. Available from: https://www.najms.org/text.asp?2013/5/5/330/112483

Dear Editor,

A 61-year-old female with the past medical history of hypertension and osteoarthritis presented to Emergency Department with sudden onset of shortness of breath and non-productive cough 30 min, after taking white willow bark supplement. The patient denied any history of the drug or supplement allergy. Pulse oximetry demonstrated oxygen desaturation; SpO 2 of 75% on ambient air and 94% on nasal cannula with the flow of oxygen 20 L/min. Arterial blood gas although on FiO 2 of 100% showed severe hypoxemia with the high A-a gradient, metabolic acidosis with respiratory compensation (pH 7.28, PCO 2 36 mmHg, PaO 2 75 mmHg, and HCO 3 19 mmol/L). Blood tests demonstrated evidence of wide anion gap (AG) metabolic acidosis (AG 14 mmol/L) from lactic acidosis (lactic acid 4.9 mmol/L) with the normal gap metabolic acidosis (∆AG/∆Bicarb = 0.4) and the patient had no osmolal gap. Furthermore, serum ketone and salicylate levels were undetectable and her chest X-ray showed bilateral interstitial infiltrates [Figure 1]. Transthoracic echocardiogram revealed normal systolic and diastolic function. The diagnosis of acute hypoxic respiratory failure secondary to severe acute respiratory distress syndrome (ARDS) from reaction to white willow bark was made; the PaO 2 /FiO 2 of 75 mmHg. The patient was promptly started on intravenous venous methylprednisolone and oral antihistamines including diphenhydramine and ranitidine. The patient responded well with our treatment and her oxygen requirement gradually improved from 94% on FiO 2 of 100% to 95% on room air. Lactic acidosis also subsided after maintaining adequate oxygenation.
Figure 1: Chest X-ray demonstrated bilateral interstitial infiltrates

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The use of white willow bark supplement was first reported back to the time of Hippocrates (400 BC) when patients were advised to chew on the bark for pain relief and fever reduction. Willow bark is also included in weight-loss products. [1] There have been a remarkably small number of reported cases of adverse reactions to willow bark extract. These adverse drug reactions are usually mild (maculopapular rashes). White willow bark induced anaphylaxis is rare; however, a few cases have been reported. [2],[3] To our knowledge, this is the first report of white willow bark induced ARDS. People who are allergic or sensitive to salicylates (such as aspirin) should not use willow bark.

  References Top

1.Astrup A, Toubro S, Cannon S, Hein P, Madsen J. Thermogenic synergism between ephedrine and caffeine in healthy volunteers: A double-blind, placebo-controlled study. Metabolism 1991;40:323-9.  Back to cited text no. 1
2.Chivato T, Juan F, Montoro A, Laguna R. Anaphylaxis induced by ingestion of a pollen compound. J Investig Allergol Clin Immunol 1996;6:208-9.  Back to cited text no. 2
3.Boullata JI, McDonnell PJ, Oliva CD. Anaphylactic reaction to a dietary supplement containing willow bark. Ann Pharmacother 2003;37:832-5.  Back to cited text no. 3


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