Acute salicylate self‐poisoning in 177 consecutive patients treated in ICU

Abstract

The course of 177 consecutive patients with severe salicylate self-poisoning treated in an intensive care unit (ICU) during a period of 15 years is presented. On admission, cerebral depression was observed in 61% respiratory failure was present in 47%, acidosis in 36% and cardiovascular function was impaired in 14%. A mortality rate of 15% was observed, which was proportionally higher in patients more than 40 years old and in patients with delayed diagnosis. Twenty-seven patients died and an autopsy was performed on 26 patients. The main autopsy diagnosis was ulcers of the gastrointestinal tract in 46%, pulmonary oedema in 46%, cerebral oedema in 31% and cerebral haemorrhage in 23%.

Concomitant overdosing of other drugs in patients with paracetamol poisoning

“…Instead, the excess mortality seemed to derive from severe ASA toxicity, and the mortality rate in this group corresponds well to that of selected patients with ASA intoxication [46,47]. In addition, ASA intoxication may result in the development of severe acidosis, which in itself is a poor prognostic feature of paracetamol poisoning [32].…”

Emergency Department Management of the Salicylate-Poisoned Patient

“…In another study, 39% of the patients who had severe salicylate poisoning requiring ICU management arrived alert with minimal symptoms [56]. Mean postmortem salicylate serum levels on 16 patients who presented dead on arrival after aspirin overdose were 51 mg/dL (range 17 to 101 mg/dL) [55].…”

“…Mean postmortem salicylate serum levels on 16 patients who presented dead on arrival after aspirin overdose were 51 mg/dL (range 17 to 101 mg/dL) [55]. Postmortem examination of salicylate-poisoned patients demonstrated several unique findings including myocardial necrosis suggestive of toxic myocarditis [57], pulmonary congestion, hemorrhagic gastritis with unabsorbed salicylate and GI ulceration, cerebral edema, and paratonia (extreme muscle rigidity) [55,56].…”

A Comparative Anaylsis of Aspirin from Various Analgesic Formulations Using Titrimetry, Spectroscopic and Hypenated Chromatographic Techniques

“…More significant signs and symptoms occur in more severe poisonings and includes high body temperature, fast breathing rate, respiratory alkalosis, metabolic acidosis, low blood potassium, low blood glucose, confusion, seizure cerebral edema, hallucinations, and coma. The most common cause of death following an aspirin overdose is cardiopulmonary arrest usually due to pulmonary edema [1]. Thus, a proper assay and quantification technique to ascertain aspirin content in a multi-component pharmaceutical dosage and its stability is indeed necessary, vital and appreciated in order to avoid overdose.…”