Aspirin poisoning

Aspirin poisoning

1. Aspirin poisoningAspirin poisoning
Important pointsImportant points::
_ _ Aspirin is widely used in clinical medicine as analgesics, antipyretics, Aspirin is widely used in clinical medicine as analgesics, antipyretics,
and antirheumaticsand antirheumatics..
_ _ The annual consumption exceeds that any other groups of drugsThe annual consumption exceeds that any other groups of drugs..
__Aspirin should not be prescribed to children aged <16 years unless there Aspirin should not be prescribed to children aged <16 years unless there
are compelling clinical indications. The particular concerns about Reye's are compelling clinical indications. The particular concerns about Reye's
syndrome usually seem to be related to higher doses of aspirin syndrome usually seem to be related to higher doses of aspirin
(>40mg/kg(>40mg/kg(.(.

2. _ Toxic effect usually appears after ingestion of:

Less than 150 milligrams of aspirin mg/kg - no symptoms to mild
toxicity.
Ingestions of 150-300 mg/kg - mild to moderate toxicity.
Ingestions of 300-500 mg/kg - serious toxicity.
Greater than 500 mg/kg - potentially lethal.

3. What happens after ingestion of toxic dose of What happens after ingestion of toxic dose of
AspirinAspirin??
_ _ It is readily absorbed from the intestineIt is readily absorbed from the intestine..
_ _ In the blood, a large percentage of aspirin is hydrolysed to In the blood, a large percentage of aspirin is hydrolysed to
salicylic acid by aspirin-splitting enzymesalicylic acid by aspirin-splitting enzyme..
_ _ Salicylic acid is equally distributed into all tissues and tissue fluids Salicylic acid is equally distributed into all tissues and tissue fluids
of the body within 30 minutes and completely excreted unchanged of the body within 30 minutes and completely excreted unchanged
within 36 hourswithin 36 hours..

4. Aspirin Poisoning SymptomsAspirin Poisoning Symptoms::
__The earliest symptoms of acute aspirin poisoning may includeThe earliest symptoms of acute aspirin poisoning may include::

ringing in the ears (tinnitusringing in the ears (tinnitus(. (.



Impaired hearingImpaired hearing..

More clinically significant signs and symptoms include rapid breathing More clinically significant signs and symptoms include rapid breathing
(hyperventilation), vomiting, dehydration, fever, double vision, and feeling (hyperventilation), vomiting, dehydration, fever, double vision, and feeling
faintfaint..

__Later signs of aspirin poisoning, or signs of more significant poisoning, Later signs of aspirin poisoning, or signs of more significant poisoning,
includeinclude::

drowsiness or confusion, bizarre behavior, unsteady walking, and comadrowsiness or confusion, bizarre behavior, unsteady walking, and coma

5. _Aspirin poisoning signs and symptoms can range from minor to
severe.
•* Mild to moderate: Deep and rapid breathing (hyperpnea)
sometimes with lethargy (abnormal drowsiness)
•* Moderate: Severe deep and rapid breathing, prominent nervous
system disturbances, such as marked lethargy or excitability, but no
coma or convulsions.
* Severe: Severe deep and rapid breathing, coma, sometimes with
convulsions.

6. ManagementManagement::
_ _ Taking a history and performing a physical examination to look for Taking a history and performing a physical examination to look for
evidence of poisoningevidence of poisoning..
_ _ Ordering laboratory tests to look for damage to organ systems that Ordering laboratory tests to look for damage to organ systems that
can be harmed by aspirin overdose and, depending on the timing, also can be harmed by aspirin overdose and, depending on the timing, also
to check for the level of aspirin in the bloodstreamto check for the level of aspirin in the bloodstream..
The initial assessment of all poison victims follows the principles of The initial assessment of all poison victims follows the principles of
basic and advanced cardiac life supportbasic and advanced cardiac life support..
Monitoring of all vital functions. Artificial respiration & respiratory Monitoring of all vital functions. Artificial respiration & respiratory
stimulants are essentialstimulants are essential..

7. Medical TreatmentMedical Treatment
The treatment of aspirin poisoning has 3 objectivesThe treatment of aspirin poisoning has 3 objectives::
To prevent further absorption of aspirin into the bodyTo prevent further absorption of aspirin into the body..
To correct dehydration and acid-base abnormalitiesTo correct dehydration and acid-base abnormalities..
To reduce the amount of salicylate within the body by To reduce the amount of salicylate within the body by
increasing the rate at which the body can get rid of itincreasing the rate at which the body can get rid of it..

8. Gastric lavage may be beneficial up to 60 minutes after
salicylate ingestion.
Warmed (38°C) isotonic sodium chloride solution may be
used.
The airway should be protected before gastric lavage.
Dialysis is another way to reduce the amount of salicylate
in the body.

9. MedicationsMedications

Activated charcoalActivated charcoal : :

To prevent more absorption, the doctor may give activated charcoal To prevent more absorption, the doctor may give activated charcoal
to absorb the salicylate from the stomachto absorb the salicylate from the stomach..

A laxative may be given with the activated charcoal to move the A laxative may be given with the activated charcoal to move the
mixture through the gastrointestinal system more rapidlymixture through the gastrointestinal system more rapidly. .

People who have been severely poisoned may be given repeated People who have been severely poisoned may be given repeated
doses of activated charcoaldoses of activated charcoal..

IV fluidsIV fluids: :

Dehydration occurs early in aspirin poisoning. To correct Dehydration occurs early in aspirin poisoning. To correct
dehydration, start an IV to correct this imbalancedehydration, start an IV to correct this imbalance. .

Also work to correct imbalances in the body's blood chemistriesAlso work to correct imbalances in the body's blood chemistries..

10. Alkaline diuresis:
This is a way to reduce the amount of salicylate in the body.
Alkaline diuresis is the process of giving a person who has been
poisoned compounds that alter the chemistry of the blood and urine
in a way that allows the kidneys to remove more salicylate.
Specifically, sodium bicarbonate is given via IV to make the blood
and urine less acidic (more alkaline), which encourages the kidneys
to capture more salicylate that can leave the body through the urine.
Sometimes, other compounds, such as potassium, also have to be
given to help with this process.

11. Other TherapyOther Therapy

The emergency physician may have to perform other procedures or The emergency physician may have to perform other procedures or
give other medications as supportive care in the case of dangerous give other medications as supportive care in the case of dangerous
aspirin overdose. These actions may include the followingaspirin overdose. These actions may include the following: :


Placing a breathing tube (intubation) and assisting breathing with a Placing a breathing tube (intubation) and assisting breathing with a
ventilator for a person who is agitated, in a coma, who cannot ventilator for a person who is agitated, in a coma, who cannot
protect their own airway, or for whom mechanical breathing could be protect their own airway, or for whom mechanical breathing could be
helpfulhelpful

Placement of a catheter into the bladder to monitor urine output and Placement of a catheter into the bladder to monitor urine output and
frequently check the acidity (pH) of the urinefrequently check the acidity (pH) of the urine

Administration of other medications as may be needed to treat Administration of other medications as may be needed to treat
agitation, convulsions (seizures), or other complications of aspirin agitation, convulsions (seizures), or other complications of aspirin
poisoningpoisoning..

12. _ The patient then should be admitted for evaluation and
follow up.
Conclusion;
_ Toxic dose of aspirin is about 10 gm single or divided doses over 24
hours.
_ Manifestation of toxicity include, nausea, vomiting, dehydration,
acidosis and may be convulsions.
_ Treatment is based on monitoring of vital function, gastric lavage
and alkaline diuresis.

13. Thank you