Salicylate (Aspirin) Poisoning
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- May occur with acute or chronic overdosage of the following:
- Acetylsalicylic acid (aspirin)
- Methyl salicylate (oil of wintergreen)
- Bismuth subsalicylate (Pepto Bismol®)
- Salicylic acid (a keratolytic)
- Other salicylate-containing drugs
- The potentially toxic acute oral dose of acetylsalicylic acid is >150 mg/kg.
- Analgesics are the most common drugs implicated in human exposures reported to U.S. poison control centers.
- Salicylate preparations constitute ~10% of all analgesic poisoning exposures reported to poison control centers.
- Ingested drug is absorbed in stomach and proximal intestine.
- With therapeutic aspirin dosing, serum levels peak in 1 to 2 hours (standard preparations) or 4 to 6 hours (enteric coated).
- After oral overdose, absorption may be prolonged and erratic.
- Acetylsalicylate ingestion may produce gastritis and may trigger centrally mediated vomiting.
- After overdose, the elimination half-life of salicylate becomes prolonged.
- As blood pH falls, the proportion of nonionized salicylate rises, and more salicylate shifts into tissues, including brain.
- Toxic salicylate exposures uncouple mitochondrial oxidative phosphorylation and increase oxygen consumption.
- Direct stimulation of the medullary respiratory center leads to hyperventilation and respiratory alkalosis.
- Multiple metabolic derangements produce a wide anion gap metabolic acidosis.
- Dehydration and electrolyte shifts are common.
- Low cerebral glucose concentrations may exist despite normal serum glucose concentrations.
- Pulmonary and/or cerebral edema may occur.
Commonly Associated Conditions
- Aspirin is often marketed in combination with other pharmaceuticals, which may complicate drug overdose situations.
- Adolescents frequently overdose on >1 drug preparation.
- Therapeutic use of acetylsalicylic acid among children with influenza has been associated with the occurrence of Reye syndrome.