Aspirin poisoning with

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

Anonymous. Poisoning with enteric-coated aspirin. Lancet 1981 2(8238) 130. 

Vermeersch and co-workers have reported the case of a 4-month-old girl who presented with agitation, hyperexcitation, fever, dehydration, polypnea and metabolic acidosis. H NMR spectroscopy of the lyophilized urine from the patient showed the presence of 2-hydroxybenzoic acid (salicylic acid), o-hydroxyhippuric acid and 2,5-dihydroxyhippuric acid, which indicated that she had been poisoned with salicylate (aspirin). It is notable that this study was completed at 80 MHz, a relatively low field strength. 

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. 

Acetaminophen (paracetamol JV-acetyl-p-aminophenoF, TYLENOL, others) is an effective alternative to aspirin as an analgesic-antipyretic agent however, its anti-inflammatory effects are much weaker. While it is indicated for pain relief in patients with noninflammatory osteoarthritis, it is not a suitable substitute for aspirin or other NSAIDs in chronic inflammatory conditions such as rheumatoid arthritis. Acetaminophen is well tolerated and has a low incidence of GI side effects. It is available without a prescription. Acute overdosage can cause severe hepatic damage, and the number of accidental or deliberate poisonings with acetaminophen continues to grow. Chronic use of less than 2 g/day is not typically associated with hepatic dysfunction. 

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, salicylates, and thiazide diuretics should not be used with allopurinol. The dose of mercaptopurine should be reduced one-third or one-fourth when used with allopurinol. Acute poisoning of colchicine should be treated with gastric lavage and activated charcoal administration. Supportive maintenance measures for blood pressure and respiration should be provided. Probenecid is used by athletes to inhibit the urinary excretion of banned anabolic steroids.85... 

A survey in Britain covering the decade of the 1980s demonstrated large numbers of successful suicides using BZs, either alone or in combination with alcohol (Serfaty et al., 1993 see also Buckley et al., 1995). Serfaty and Masterton (1993) found 891 fatalities with BZs alone and 591 in combination with alcohol. The total of all poisonings attributed to BZs was 1,576 during the 10-year period, putting them ahead of aspirin/ salicylates at 1,308 as well as amitriptyline (1,083) and dothiepin at 981. 

As with paracetamol, overdoses of aspirin are unfortunately taken by people as a means of suicide, although the amount that has to be taken for a fatal dose is greater than for paracetamol. There are probably several hundred deaths per year from aspirin overdose worldwide, and in a recent year 10,000 calls to Poison Control Centers relating to aspirin overdose were reported in the USA. 

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