| Salicylate poisoning | |
|---|---|
| Other names | Salicylism, salicylate toxicity, aspirin poisoning, aspirin toxicity, aspirin overdose |
 | |
| A skeletal structural formula for aspirin. | |
| Specialty | Emergency medicine |
| Symptoms | Ringing in the ears, nausea, abdominal pain, fast breathing rate[1] |
| Complications | Swelling of the brain or lungs, seizures, low blood sugar, cardiac arrest[1] |
| Diagnostic method | Early: Slightly elevated blood aspirin levels ~ 2.2 mmol/L (30 mg/dL, 300 mg/L), respiratory alkalosis[1] Late: Metabolic acidosis[1] |
| Differential diagnosis | Sepsis, heart attack, agitation[1] |
| Prevention | Child-resistant packaging, low number of pills per package[1] |
| Treatment | Activated charcoal, intravenous sodium bicarbonate with dextrose and potassium chloride, dialysis[2] |
| Prognosis | ~1% risk of death[3] |
| Frequency | > 20,000 per year (US)[1] |
Salicylate poisoning, also known as aspirin poisoning, is the acute or chronic poisoning with a salicylate such as aspirin.[1] The classic symptoms are ringing in the ears, nausea, abdominal pain, and a fast breathing rate.[1] Early on, these may be subtle, while larger doses may result in fever.[1][4] Complications can include swelling of the brain or lungs, seizures, low blood sugar, or cardiac arrest.[1]
While usually due to aspirin, other possible causes include oil of wintergreen and bismuth subsalicylate.[2] Excess doses can be either on purpose or accidental.[1] Small amounts of oil of wintergreen can be toxic.[2] Diagnosis is generally based on repeated blood tests measuring aspirin levels and blood gases.[1] While a type of graph has been created to try to assist with diagnosis, its general use is not recommended.[1] In overdose maximum blood levels may not occur for more than 12 hours.[2]
Efforts to prevent poisoning include child-resistant packaging and a lower number of pills per package.[1] Treatment may include activated charcoal, intravenous sodium bicarbonate with dextrose and potassium chloride, and dialysis.[2] Giving dextrose may be useful even if the blood sugar is normal.[2] Dialysis is recommended in those with kidney failure, decreased level of consciousness, blood pH less than 7.2, or high blood salicylate levels.[2] If a person requires intubation, a fast respiratory rate may be required.[1]
The toxic effects of salicylates have been described since at least 1877.[5] In 2004, more than 20,000 cases with 43 deaths were reported in the United States.[1] About 1% of those with an acute overdose die, while chronic overdoses may have severe outcomes.[3] Older people are at higher risks of toxicity for any given dose.[5]
- ^ a b c d e f g h i j k l m n o p q O'Malley, GF (May 2007). "Emergency department management of the salicylate-poisoned patient". Emergency Medicine Clinics of North America. 25 (2): 333–46, abstract viii. doi:10.1016/j.emc.2007.02.012. PMID 17482023.
- ^ a b c d e f g Walls, Ron (2017). Rosens Emergency Medicine Concepts and Clinical Practice (9th ed.). Elsevier. p. X. ISBN 978-0323354790.
- ^ a b McNeil Consumer & Specialty Pharmaceuticals (2002). "Assessment of Safety of aspirin and other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)". FDA. Archived from the original on 14 May 2017. Retrieved 27 June 2017.
- ^ Brenner, George M.; Stevens, Craig (2012). Pharmacology E-Book: with STUDENT CONSULT Online Access (4 ed.). Elsevier Health Sciences. p. 319. ISBN 978-1455702787. Archived from the original on 2017-08-18.
- ^ a b Roland, Peter S.; Rutka, John A. (2004). Ototoxicity. PMPH-USA. p. 28. ISBN 9781550092639. Archived from the original on 10 September 2017. Retrieved 27 June 2017.