An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose

Abstract

Objective: To develop a flowchart to be used as a tool to guide clinicians step by step through the management of salicylate poisoning. Methods: A comprehensive literature search was carried out. Results: The evidence base was used to develop a management flowchart that guides the clinician through the three main steps in caring for the patient with salicylate poisoning: preventing further absorption, assessing the severity of poisoning and, where appropriate, increasing elimination. Conclusions: Salicylate poisoning can result in severe morbidity and mortality and this flowchart provides an evidence based guideline that will guide clinicians through the management of patients presenting to the emergency department with salicylate poisoning.

Treatment of lethal acetylsalicylic acid poisoning without hemodialysis

“…6 Severe poisoning is classified as a serum acetylsalicylic acid level >75 mg/dL. 4 In the present patient, her electrolyte balance and renal function were normal. Her serum acetylsalicylic acid level on admission was over 100 mg/dL.…”

“…Although hemodialysis has been used successfully for many years in the management of severe acetylsalicylic acid poisoning, no controlled trial comparing its efficacy with that of carefully managed urinary alkalinization and diuresis has been carried out. 4 Our case illustrates that even patients with severe acetylsalicylic acid poisoning can be treated with rigorous urinary alkalinization, diuresis, and critical supportive care. However, preparation to be able to perform emergent hemodialysis if needed is important.…”

“…3 Rapid alkalinization by sodium bicarbonate is useful for decreasing the amount of acetylsalicylic acid crossing the blood-brain barrier and increasing renal clearance. 4 However, if the plasma acetylsalicylic acid concentration is higher than 100 mg/dL, hemodialysis should be considered with or without clinical findings. 5 We encountered a severe acetylsalicylic acid poisoning patient whose plasma concentration of acetylsalicylic acid was higher than 100 mg/dL.…”

An adult can still die of salicylate poisoning in France in 2008

“…Acidemia appears late in salicylate poisoning evolution, and we should not wait for it to mention this diagnosis. Rapid alkalinisation by sodium bicarbonate would have been useful for decreasing the amount of salicylate crossing through the blood brain barrier and increase renal clearance [3].…”

“…Severe salicylate poisoning should be quickly considered in case of both confusion and metabolic acidosis, leading to a rapid alkalinisation and haemodialysis [3]. In all the published cases, a delayed diagnosis was associated with increased mortality [5].…”