Substance Overview: Aspirin, also known as acetylsalicylic acid, is a common medication used to reduce pain, fever, and inflammation. However, in high doses, it can lead to toxicity known as salicylate poisoning. Clinical Findings: Symptoms of aspirin toxicity may include tinnitus (ringing in the ears), hyperventilation, nausea, vomiting, and confusion. In severe cases, it can cause respiratory alkalosis and metabolic acidosis. Laboratory Tests: Detection of aspirin toxicity involves measuring blood salicylate levels. Other tests may include arterial blood gases, electrolytes, and renal function to assess the severity of poisoning. Treatment: Management includes activated charcoal if ingestion is recent, intravenous fluids, electrolyte correction, and in severe cases, hemodialysis to remove salicylates from the blood. Prevention: Preventing aspirin toxicity involves using the medication as directed, keeping it out of reach of children, and being aware of its presence in many over-the-counter products.

1. Aspirin Toxicity
Group 6

2. A 61-year-old woman presented to the Emergency Department after
awakening with left-sided weakness. She had a history of ischemic stroke
with an associated seizure disorder. The patient denied recent seizure, and
brain magnetic resonance imaging (MRI) showed no evidence of an acute
stroke. Following her arrival, she became acutely confused and complained of
tinnitus, shortness of breath, and blurred vision. On direct questioning, she
gave a history of excessive use of salicylate for the previous two to three
weeks. Her initial serum salicylate level was significantly increased at 78.1
mg/dl (upper therapeutic limit, 19.9 mg/dl). She recovered completely
following treatment with oral activated charcoal, intravenous sodium
bicarbonate, and potassium replacement.
Case

3. 1 2
Aspirin (acetylsalicylic acid) is
a pharmaceutical drug
classified as a non-steroidal
anti-inflammatory drug
(NSAID).
Description
mild to moderate pain
fever
swollen, red and tender
body tissues
rheumatoid arthritis
rheumatic fever
Its analgesic, antipyretic,
and anti-inflammatory
properties is used to treat:

5. Phase 2 of Aspirin Toxicity
Clinical Findings
Phase 1 of Aspirin Toxicity
It is characterized by
hyperventilation resulting
from direct respiratory
center stimulation, leading to
respiratory alkalosis and
compensatory alkaluria.
Paradoxical aciduria in the
presence of continued
respiratory alkalosis occurs
when sufficient potassium
has been lost from the
kidneys.

6. Phase 3 of Aspirin Toxicity Other Symptoms
Clinical Findings
Includes dehydration,
hypokalemia, and progressive
metabolic acidosis.
It may begin 4-6 hours after
ingestion in a young infant or 24
hours or more after ingestion in
an adolescent or adult.
Earliest signs and symptoms:
Nausea, vomiting, diaphoresis,
vertigo, hyperventilation,
tachycardia, and hyperactivity
As toxicity progresses,
agitation, delirium,
hallucinations, convulsions,
lethargy, and stupor may occur.

7. Lab Identification
Ferric Chloride Test
1.
Natelson Test
2.

8. Salicylate Level
Test
Other laboratory methods used to detect aspirin:
Arterial
Blood Gas
Serum
Electrolytes
Urinalysis
Measures the amount
of salicylates in the
blood which helps
diagnose acute or
gradual aspirin
poisoning.
Helps assess
the acid-base
status of
patients
Measures the
level of serum
potassium and
glucose
Monitors the
progress of
aspirin
poisoning.

9. Renal Function
test
Other laboratory methods used to detect aspirin:
Liver
Function Tests
Plasma
Creatinine
Coagulation
studies
Aspirin
toxicity can
result in renal
dysfunction.
Includes
measurement
of ALT and
AST.
Helps in
monitoring
kidney
function
Measurement
of prothrombin
time,
activated
partial
thromboplastin
time, and
platelet count

10. Activated
Charcoal
Treatment
“There is no antidote for aspirin overdose.”
The goals: limit absorption of aspirin, enhance elimination of salicylate, & supportive care.
Alkaline Diuresis
with Extra
Potassium Chloride
Avoid Drugs: Fever
Management
ASAP
Repeat 4 hours
until charcoal
appears in stool
Correct electrolytes
Urine pH≥ 8
Symptomatic-No delay
1 L of 5% D/W, 3 50-
mEq ampules of sodium
bicarbonate, and 40
mEq of potassium
chloride at 1.5 to 2
times the maintenance
IV fluid rate.
Monitor serum K
Drugs increasing
urinary bicarbonate
(e.g., acetazolamide)
worsen metabolic
acidosis.
Drugs decreasing
respiratory drive
impair
hyperventilation and
respiratory alkalosis.
Use physical
measures
(e.g., external
cooling).
Unless
contraindicated
(eg, by altered
mental status)

11. Seizure
Treatment:
Treatment
“There is no antidote for aspirin overdose.”
The goals: limit absorption of aspirin, enhance elimination of salicylate, & supportive care.
Rhabdomyolysis:
Consider
Hemodialysis
Ensure
adequate
hydration and
urine output.
Alkaline
diuresis may
prevent renal
failure.
For severe neurologic
impairment, renal or
respiratory
insufficiency,
acidemia despite
other measures, or
very high serum
salicylate levels.
Administer
benzodiazepines

12. Safe Dosage (Normal Doses)
1.
Be cautious with concentrated salicylate products.
Gradual Use (Unintentional)
2.
Unintentional poisoning over time, but Low-dose
aspirin for prevention is safe.
Avoid Salicylates Other Than Aspirin
3.
Oil of wintergreen (methyl salicylate) - highly
concentrated and found in liniments and vaporizers.
Pure oil of wintergreen (1 teaspoon) = about 7000
milligrams (22 adult tablets) of aspirin.
Monitor and maintain only at therapeutic dosage (3-
10mg/dL to 70 to 140 mg/dL
4.
Prevention

13. Alcohol and Drug Foundation. (2023, January 10). ADF - Drug Facts - Aspirin. ADF
- Alcohol & Drug Foundation. https://adf.org.au/drug-facts/aspirin/
O’Malley, G. F., & Rika O’Malley. (2022, May 2). Aspirin Poisoning. MSD Manual
Consumer Version; MSD Manuals. https://www.msdmanuals.com/home/injuries-and-
poisoning/poisoning/aspirin-poisoning
Waseem, M. (2021). Salicylate Toxicity: Practice Essentials, Etiology and
Pathophysiology, Epidemiology. EMedicine.
https://emedicine.medscape.com/article/1009987-overview#
References