ACETYLSALICYLIC ACID (aspirin) POISONING

Overdose of ASA, due to consumption of >10 g of ASA in adults and 3 g in children.

Clinical features

  • Mild to moderate toxicity (after 1-2 hours): hyperventilation, tinnitus, deafness, nausea, vomiting, dizziness, vasodilation
  • Severe toxicity: hyperpyrexia, convulsions, altered mental status, non cardiac pulmonary oedema, coma
  • Complex acid-base disturbances (acidosis)

Management

Stabilise vital signs
  • Oxygen and IV fluids as necessary
  • Gastric lavage: worthwhile up to 4 hours after poisoning as stomach emptying is delayed
  • Activated charcoal 50 g repeated as needed every 4 hours or 25 g repeated prn every 2 hours
    • It delays absorption of any remaining salicylate
  • Treat/prevent hypoglycaemia with Dextrose 50% 50-100 ml (Dextrose 10% 2-5 ml/kg in children)
  • Tepid sponging for hyperpyrexia
  • Treat convulsions with IV diazepam 10 mg prn
Refer to higher level of care if coma, pulmonary oedema, renal insufficiency, clinical deterioration in spite of above measures
  • Treat acidosis and enhance renal excretion in symptomatic patients with Sodium bicarbonate
    • Bolus 1-2 mEq/kg (max 100 mEq) in 3-5 minutes
    • Followed by an infusion of 50-75 mEq in 500 ml of Dextrose 5 %; run at 250 ml/hour in adults (run at 1.5-2 times maintenance in children)
    • Mantain urine pH 7.5-8