What are the effects of an Acetylsalicylic acid (aspirin) overdose?

From the Guidelines

Aspirin overdose should be treated with extracorporeal treatment, such as hemodialysis, in severe cases, as recommended by the Extracorporeal Treatment in Salicylate Poisoning systematic review and recommendations from the EXTRIP workgroup 1. Aspirin overdose is a serious medical emergency that requires immediate attention. If you suspect an aspirin overdose, call poison control or go to the emergency room immediately. Symptoms of overdose include ringing in the ears, nausea, vomiting, rapid breathing, confusion, seizures, and in severe cases, coma.

Treatment Options

• Activated charcoal to prevent further absorption if the ingestion was recent
• Intravenous fluids to correct dehydration and electrolyte imbalances
• Possibly hemodialysis in severe cases, as supported by the EXTRIP workgroup recommendations 1 The severity of an aspirin overdose depends on the amount ingested, with toxic doses generally considered to be above 150 mg/kg body weight. Aspirin (acetylsalicylic acid) causes toxicity by disrupting the body's acid-base balance, affecting multiple organ systems including the central nervous system, respiratory system, and metabolic processes.

Prevention and Vulnerable Populations

• Children are particularly vulnerable to aspirin toxicity, which is why aspirin is not recommended for those under 18 years of age except under specific medical supervision
• Prevention includes keeping medications out of reach of children, using child-resistant containers, and properly disposing of unused medications.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Aspirin Overdose Symptoms and Treatment

• Aspirin overdose can cause a range of symptoms, including mixed acid-base disturbance with respiratory alkalosis and metabolic acidosis, altered mental status, and confusion 2.
• The goals of therapy for aspirin overdose depend primarily on limiting the absorption of salicylate, enhancing elimination, and providing supportive care 2.
• Treatment options for aspirin overdose include:
  • Aggressive hydration to maintain euvolemia
  • Alkalinization
  • Aggressive replenishment of potassium and magnesium
  • Activated charcoal to decrease absorption
  • Hemodialysis in severe cases 2, 3, 4

Diagnosis and Monitoring

• Diagnosis of acute salicylate intoxication is generally not problematic, with patients often presenting with a history of intentional overdose, hyperventilation, fever, and nausea 5.
• Chronic intoxication can pose a diagnostic dilemma, with atypical presentations mimicking other disease states 5.
• Monitoring of acid-base status and serum salicylate levels is crucial in managing aspirin overdose 2, 3.
• Rebound increase in salicylate levels can occur, and close monitoring is necessary to prevent this 2.

Prevention and Risk Factors

• Chronic salicylate intoxication is more common in the elderly, and can occur with therapeutic doses 5.
• Increased toxicity in older patients often appears due to inadvertent overdosage or dual prescribing of salicylates 5.
• Systemic clearance of salicylate is reduced with age, and renal elimination is also decreased, increasing the risk of toxicity 5.
• Patients with impaired renal function are at higher risk of salicylate toxicity, and treatment should be tailored accordingly 3.