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Home | Articles | Poisoning | Aspirin

Aspirin

Last updated 3rd December 2020

Last updated on 19th May 2014 by Calum Murray

Toxicity

  1. All patients who have taken >125mg/kg, or those who are symptomatic should be referred for medical assessment

Clinical Features

  1. Commonly causes lethargy, nausea, vomiting, tinnitus. 
  2. A mixed respiratory alkalosis (by direct stimulation of respiratory centre) and metabolic acidosis is the rule.
  3. Severe poisoning likely with ingestion >500mg/kg, causing metabolic acidosis, renal failure, pulmonary oedema and CNS effects (agitation, confusion, coma, fits). Metabolic acidosis & CNS features carry poor prognosis & should always be taken seriously

General Management

  1. If ingestion of >125mg/kg has taken place within 1 hour of presentation then give 50g of activated charcoal. 
  2. Consider second dose charcoal for patients in whom plasma level continues to rise, suggesting delayed gastric emptying 
  3. Where the practical expertise exists, consider gastric aspiration/lavage in adults within 1 hour of a potentially life-threatening overdose, providing the airway can be protected.

Mild Poisoning – Need for Rehydration with Fluids

  1. In adults a salicylate level <300 mg/L and in children/elderly <200 mg/L, and no symptoms – rehydrate with oral fluids.
  2. In adults a salicylate level of 300 – 500 mg/L and children/elderly 200 – 450 mg/L, with mild symptoms eg lethargy, nausea, vomiting, tinnitus – rehydrate with IV fluids.

Moderate Poisoning – Need for Urinary Alkalinisation

  1. If the salicylate concentration in adults is greater than 500 mg/L then give 225 mmol sodium bicarbonate (225 mL of 8.4% over 60 minutes or 1.5 L of 1.26% over 2 hours).
  2. Further sodium bicarbonate (8.4%) may be needed to maintain the urine pH 7.5-8.5. The urinary pH should be checked hourly. 
  3. The plasma salicylate concentration should be repeated 2 hourly to ensure that treatment has been effective. 
  4. Potassium infusions should be given as necessary to keep plasma potassium in the range of 4.0-4.5 mmol/L as hypokalaemia will make it difficult to achieve adequate urinary alkalinisation.
  5. Forced diuresis should not be used since it does not enhance salicylate excretion and may cause pulmonary oedema

Severe Poisoining – Need for Haemodialysis

  1. Haemodialysis or haemodiafiltration is treatment of choice for severe poisoning and should be arranged for patients with:
    1. Salicylate level >900mg/l
    2. Renal failure
    3. Congestive cardiac failure
    4. Non-cardiogenic pulmonary oedema
    5. Coma
    6. Convulsions
    7. CNS effects not resolved by correction of acidosis
  2. In the presence of symptoms suggestive of severe salicylate poisoning, haemodialysis should also be considered for:
    1. Severe metabolic acidosis with H+ >63 nanomoles/L
    2. Persistently high salicylate concentrations unresponsive to urinary alkalinisation
    3. Plasma concentrations greater than 700mg/L

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