Poisoning aspirin

The supportive treatment of aspirin poisoning may include gastric lavage (to prevent the further absorption of salicylate), fluid replenishment (to offset the dehydration and oliguria), alcohol and water sponging (to combat the hyperthermia), the administration of vitamin K (to prevent possible hemorrhage), sodium bicarbonate administration (to combat acidosis) and, in extreme cases, peritoneal dialysis and exchange transfusion. 

Mild antiinflammatory doses will produce salicylate intoxication, also known as salicylism. The symptoms of this syndrome include dizziness, tinnitus, vertigo, reversible impairment of hearing and vision, excitement and mental confusion, hyperventilation, and electrolyte imbalance. Aspirin poisoning is an acute emergency and may result in death. In case of poisoning, the drug must be eliminated from the body as early as possible. 

With regard to deaths from aspirin poisoning which of the following is/are true a some are accidental... 

Answer B. If the patient had been able to mention tinnitus, this would be a classic case of aspirin poisoning. At high salicylate blood levels, the combination of effects leading to respiratory depression (respiratory acidosis) and metabolic acidosis results in the observed pH and electrolyte changes, the anion gap (a marker for acidosis), and hyperthermia. 

The United Kingdom introduced legislation in 1974 requiring some pharmaceutical products, such as junior aspirin, to be fitted with child resistant closures. One year later the legislation was extended to cover adult aspirin. Admissions to hospital for children under 5 years with aspirin poisoning showed a dramatic reduction of 85% during the period 1975 to 1978 [16]. 

Aspirin poisoning leads to inappropriate vasodilation compounded by volume depletion and acidosis, which worsens vasodilation. Aggressive volume repletion with intravenous fluids should be instituted. The aim is to achieve large-volume diuresis to optimize salicylate elimination. If necessary, vasopressors (e.g., norepinephrine, phenylephrine) are added. 

Salicylate, which is a degradation product of aspirin in the human, is lipid soluble and has a dissociable proton. In high concentrations, as in salicylate poisoning, salicylate is able to partially uncouple mitochondria. The decline of ATP concentration in the cell and consequent increase of AMP in the cytosol stimulates glycolysis. The overstimulation of the glycolytic pathway (see Chapter 22) results in increased levels of lactic acid in the blood and a metabolic acidosis. Fortunately, Dennis Veere did not develop this consequence of aspirin poisoning (see Chapter 4). 

Accidental ingestion of aspirin by young children in the home remains a major problem in many countries despite the introduction of child-resistant containers (27 ). The ready availability and palatability of junior aspirin may be a factor — these preparations are not available in India where aspirin poisoning seems to be very rare in young children (29 ). Therapeutic overdosage in adults has already been mentioned (18, 19, 23 ), and some bizarre presentations have been recorded. 

Aspirin is acetylsalicylic acid and is used as an antiplatelet agent and for pain relief. Its use for anti-inflammatory effects is limited by the occurrence of side-effects, which include tinnitus and deafness, both features of salicylate poisoning. 

When a specific antidote or other treatment is under consideration, quantitative laboratory testing may be indicated. For example, determination of the acetaminophen serum level is useful in assessing the need for antidotal therapy with acetylcysteine. Serum levels of salicylate (aspirin), ethylene glycol, methanol, theophylline, carbamazepine, lithium, valproic acid, and other drugs and poisons may indicate the need for hemodialysis (Table 58-3). 

Aspirin (acetylsalicylic acid) and other salicylates are still a common cause of human poisoning, both therapeutic and suicidal, and account for a significant number of deaths each year. Although the toxic effects have a biochemical basis, some of the effects caused are clearly physiological, and consequently, it has been used as an example in this category. 

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