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

From the Guidelines

Aspirin overdose is a medical emergency that can lead to severe morbidity and mortality, and immediate attention is required to prevent long-term damage to the brain, lungs, and kidneys. The effects of an aspirin overdose can be devastating, with symptoms including ringing in the ears, nausea, vomiting, rapid breathing, confusion, seizures, and in severe cases, coma 1. Treatment typically involves activated charcoal to prevent further absorption if the ingestion was recent, intravenous fluids to correct dehydration and electrolyte imbalances, and possibly hemodialysis in severe cases.

The severity of aspirin overdose depends on the amount ingested, with toxic doses generally exceeding 150-200 mg/kg body weight. Aspirin (acetylsalicylic acid) causes toxicity by disrupting the body's acid-base balance, affecting multiple organ systems including the brain, lungs, and kidneys 1. It also interferes with blood clotting and can cause metabolic acidosis.

Some key points to consider in the management of aspirin overdose include:

• Immediate attention is required to prevent long-term damage
• Activated charcoal may be used to prevent further absorption
• Intravenous fluids and hemodialysis may be necessary in severe cases
• The risk of aspirin overdose can be mitigated by keeping medications secure, using child-resistant containers, and never taking more than the recommended dose 1.

In terms of prevention, it is essential to follow dosing instructions carefully and be aware that aspirin is found in many combination products. Additionally, patients should be educated on the risks of aspirin overdose and the importance of seeking immediate medical attention if an overdose is suspected. The use of extracorporeal treatment, such as hemodialysis, may be necessary in severe cases of aspirin overdose, and clinical recommendations for its use have been established by the EXTRIP workgroup 1.

From the FDA Drug Label

Warnings Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding The chance is higher if you are age 60 or olderHave had stomach ulcers or bleeding problemsTake a blood thinning (Anticogulant) or steroid drugTake other drugs containing prescription or nonprescription NSAIDs (aspirin, ibuprofen, naproxen, or others)have 3 or more alcoholic drinks every day using this product Seek medical help right away.You experience any of the following signs of stomach bleeding: feel faint, vomt blood, have bloody or black stools, have stomach pain that does not get better,

The effects of an Acetylsalicylic acid (Aspirin) overdose may include stomach bleeding, which can be severe. Signs of stomach bleeding include:

• Feeling faint
• Vomiting blood
• Bloody or black stools
• Stomach pain that does not get better 2 2

From the Research

Effects of Acetylsalicylic Acid (Aspirin) Overdose

• Aspirin overdose can cause significant morbidity and mortality, with symptoms ranging from mild to severe toxicity 3, 4, 5.
• The severity of aspirin overdose is categorized based on the dose ingested and the resulting salicylate concentration, with potentially lethal doses being over 500 mg/kg 4.
• Clinical effects of aspirin overdose include:
  • Mild toxicity: nausea, vomiting, tinnitus, or hyperventilation, typically occurring at doses around 160 mg/kg 5.
  • Moderate toxicity: acid-base disturbance, confusion, typically occurring at doses around 297 mg/kg 5.
  • Severe toxicity: coma or seizures, although no cases of severe toxicity due to aspirin alone were reported in one study 5.

Treatment of Aspirin Overdose

• Activated charcoal administration can decrease the absorption of aspirin and reduce peak salicylate concentrations 5.
• Urinary alkalization using bicarbonate can enhance the elimination of salicylate and reduce the apparent elimination half-life 5, 6.
• Hemodialysis (HD) is widely advocated for managing severe salicylate intoxications, but the optimal duration and mode of therapy are unclear 3, 7.
• Continuous renal replacement therapy (CRRT) may have a role in severe salicylate toxicity to enhance ongoing clearance after an initial round of HD 7.

Complications of Aspirin Overdose

• Aspirin overdose can cause acid-base disturbances, organ dysfunction, and even death 3, 4, 5.
• Patients with severe salicylate poisonings may require extended durations of HD to effectively mitigate toxicity 3.
• Repeated doses of charcoal may be a worthwhile intervention when there is no risk of aspiration, especially in patients with impaired renal function 4.