Indications include severe acidosis pH less than 7. Watch for the development of signs of severe aspirin toxicity, such as hypotension, altered mental status, seizures, and pulmonary edema. Monitor for volume overload during fluid resuscitation. The medical management of aspirin overdose usually lasts on the order of days, with improvement in most cases.
However severe cases may require prolonged supportive care in the intensive care unit dealing with the consequences of metabolic acidosis, arrhythmias, pulmonary edema, and altered mental status. Once the medical management is complete, psychiatric evaluation is required in cases of intentional overdose. For accidental overdoses, education of patients and caregivers is essential in preventing recurrence.
For example, aspirin-containing products should be moved out of the reach of children and patients with dementia. Medisets may be helpful for psychiatric or dementia patients who require therapeutic aspirin.
Aspirin levels may initially be undetectable or low, but in large ingestions, absorption can be unpredictable due to the formation of concretions. Levels may peak suddenly and erratically as the concretion dissolves. Intubation can be problematic as patients often have significant protective hyperventilation while awake. Most patients who are intubated should be prepared for hemodialysis for this reason.
Renal insufficiency can greatly prolong elimination of salicylates. Nephrology should be consulted early on for consideration of initiation of hemodialysis. Glucose levels should be monitored more frequently every hours since patients with liver insufficiency are at increased risk for hypoglycemia. As with all patients with ingestions, it is important to rule out coingestion of acetaminophen, which would be more toxic in this population.
During fluid resuscitation, patients should be monitored more frequently for signs and symptoms of volume overload, with a lower threshold to consult nephrology for hemodialysis. Consider increased frequency of monitoring history, stool guaiac test, hemoglobin level if there is a history of GI bleed.
Consider increased frequency of monitoring for GI bleed history, stool guaiac test, hemoglobin level. Initial management remains as detailed above, but patients will require further evaluation for methods to prevent future overdose i. Inpatient care will usually last days if there is no evidence of severe toxicity and the patient is cleared by psychiatry. In addition, the ABG should show resolution of metabolic acidosis and respiratory alkalosis. Initial ABG testing often reveals this mixed respiratory alkalosis and metabolic acidosis.
Body temperature may be elevated. Severe hyperthermia may occur in serious cases. Unless contraindicated eg, by altered mental status , activated charcoal is given as soon as possible and, if bowel sounds are present, may be repeated every 4 hours until charcoal appears in the stool. Alkaline diuresis is indicated for patients with any symptoms of poisoning and should not be delayed until salicylate levels are determined. This intervention is usually safe and exponentially increases salicylate excretion.
Because hypokalemia Hypokalemia Hypokalemia is serum potassium concentration 3. The most common cause is Serum potassium is monitored. Because fluid overload can result in pulmonary edema Pulmonary Edema Pulmonary edema is acute, severe left ventricular failure with pulmonary venous hypertension and alveolar flooding.
Findings are severe dyspnea, diaphoresis, wheezing, and sometimes blood-tinged Fever can be treated with physical measures such as external cooling Cooling techniques Heatstroke is hyperthermia accompanied by a systemic inflammatory response causing multiple organ dysfunction and often death. Seizures are treated with benzodiazepines. In patients with rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue.
Treating acid-base alterations in salicylate-poisoned patients who require endotracheal intubation and mechanical ventilation for airway protection or oxygenation can be extremely challenging. In general, intubated patients should probably be dialyzed and closely monitored by a critical care specialist. Salicylate poisoning causes respiratory alkalosis and, by an independent mechanism, metabolic acidosis.
Consider salicylate toxicity in patients with nonspecific findings eg, alteration in mental status, metabolic acidosis, noncardiogenic pulmonary edema, fever , even when a history of ingestion is lacking.
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This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Fluid resuscitation, electrolyte replacement, and symptomatic and supportive care measures should also be initiated with salicylate overdose.
In severe aspirin overdose, hemodialysis is warranted. It can rapidly remove aspirin from the blood and correct acid-base and electrolyte disturbances.
However, in overdose situations, the protein binding becomes saturated leading to more free aspirin in the blood to cause toxicity. This free aspirin is what warrants the use of hemodialysis. Initiation of intubation and mechanical ventilation pose great risk for a seriously salicylate-poisoned patient.
Many deaths occur within minutes to hours of the procedure. Even a temporary rise in pCO2 can initiate transfer of salicylate into the tissue.
The sudden decrement in energy production, especially in the brain, can cause precipitous cardiovascular collapse and death. Intubation should not be performed unless the patient is in respiratory failure with hypoxemia and falling pH.
Prophylactic intubation is contraindicated. The most experienced person available should perform the procedure. The Missouri Poison Center stands ready to consult on salicylate exposures.
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