Acute and chronic effects of aspirin toxicity and their treatment

Abstract

Salicylate poisoning remains a major clinical hazard, usually resulting from accidental ingestions in preschool children, suicidal overdoses in adults and teenagers, and therapeutically acquired intoxication in all ages. Alkalemia or acidemia, alkaluria or aciduria, hypoglycemia or hyperglycemia, and water and electrolyte imbalances may occur; nausea, vomiting, tinnitus, hyperpnea, hyperpyrexia, disorientation, coma, and/or convulsions are common. With chronic, therapeutically induced salicylism, these symptoms may be mistaken for symptoms resulting from the illness for which the salicylates were administered. For acute ingestions, the magnitude of the poisoning is clearly dose related. Blood level determinations are good prognostic indicators for acute ingestions but are of limited value in chronic, therapeutically induced salicylism. Fluid and electrolyte management is the mainstay of therapy. Diuresis, hemodialysis, and hemoperfusion are effective, but the latter two rarely are necessary.

Measuring plasma salicylate concentrations in all patients with drug overdose or altered consciousness: is it necessary?

“…Poisoning requiring therapeutic intervention (plasma salicylate concentration usually greater than 400-500 mg/l) is usually indicated by the presence of symptomatic tinnitus and other symptoms or signs such as vomiting, tachypnoea, and sweating. [2][3][4] Plasma salicylate concentrations are measured in a significant number of patients even when there is no clinical evidence of toxicity. At the time of this study, in the emergency department (ED) of St. Thomas' Hospital, London, all adult patients were screened for both paracetamol and salicylate poisoning following presentation with any suspected drug overdose.…”

Salicylate toxicity from ingestion of traditional massage oil

“…Severe salicylate poisoning is usually associated with plasma salicylate concentration of 70 mg/dl or more. The acutely toxic dose of aspirin is generally considered greater than 150 mg/kg of body mass,7 and a potentially lethal dose is greater than 500 mg/kg 8…”

Complete recovery after profound acidosis (pH 6.49).

“…Several factors contribute to the degree of passage of salicylate into the cerebrospinal fluid. 4 The important factor in the context of this discussion is that of acid base balance. It is known that the distribution of salicylate between the extra-and intracellular compartments is influenced by the pH of both compartments.…”