Treatment of lethal acetylsalicylic acid poisoning without hemodialysis

Abstract

Case: A woman aged in her 20s ingested approximately 99 g acetylsalicylic acid, and was transported to our hospital 2 h later. She was lucid, but complained of hearing loss and tinnitus. We performed gastric lavage and gave her activated charcoal several times. We attempted to maintain the urinary pH at 7.5 and output above 100 mL/h while preparing for urgent hemodialysis.Outcome: It was revealed after discharge that the blood concentration of acetylsalicylic acid was 103.8 mg/dL on admission (lethal dose level) and had decreased to 35.4 mg/dL by the next morning. The half-life was 8.5 h. Conclusion:Hemodialysis is strongly recommended for patients who take a lethal dose of acetylsalicylic acid. However, by carefully evaluating the vital signs and urinary output and pH, while preparing for emergency hemodialysis, we consider that it is possible to treat acetylsalicylic acid poisoning by alkaline diuresis and critical supportive care.

Management of pharmaceutical and recreational drug poisoning

“…This beneficial effect of increasing urine pH was also reported by Morgan et al [137] when indirectly comparing two sets of patients with moderate and extreme urinary pH of 6.60 [6.00-7.05] and 7.88 [7.60-8.00], respectively. Several case reports have also demonstrated the value of urine alkalinization [138][139][140]. Thus, despite their poor quality, several studies have confirmed the enhanced urinary elimination of salicylates induced by urine alkalization.…”

“…Thus, despite their poor quality, several studies have confirmed the enhanced urinary elimination of salicylates induced by urine alkalization. These results have been repeatedly considered to be sufficient to recommend urine alkalization as an adequate first-line treatment for salicylate poisoning, avoiding the need for haemodialysis [133,[140][141][142].…”