A 19-year-old at 37 weeks gestation with an acute acetylsalicylic acid overdose

Abstract

Acute salicylate overdose in pregnancy is potentially fatal for both the mother and fetus and presents a unique challenge in intensive care management. While suggested thresholds exist for hemodialysis in adults with toxic salicylate ingestion, it is unclear if these thresholds remain appropriate for the gravid patient, particularly given that medications such as acetylsalicylic acid may cross the placental barrier and accumulate in the fetal bloodstream. We describe a case of a gravid patient at ∼37 weeks gestational age with a self-reported acetylsalicylic acid ingestion of 32.5 g and review prior cases of both acute and chronic salicylate ingestion in pregnancy in order to determine the clinical precedent for hemodialysis in this situation.

Toxic Ingestion of Acetaminophen and Acetylsalicylic Acid in a Parturient at 33 Weeks Gestation: A Case Report

“…11,12 For these physiologic reasons, fetal effects of maternal ASA toxicity can also be extremely detrimental, with reports ranging from nonreassuring fetal heart rate tracing requiring emergency cesarean delivery to fetal demise. [13][14][15] The patient's salicylate and APAP concentrations measured shortly after ingestion suggest that she may have consumed a lower dose of toxins than reported. Although the patient's only apparent symptom of acute ASA overdose was a change in hearing, the fetal effects of these ingestions appeared to be much more significant, with fetal tachycardia and decelerations on fetal heart monitoring.…”