From the Guidelines
Aspirin overdose is a life-threatening condition that requires immediate medical attention, and treatment should be guided by the most recent and highest quality evidence, which recommends extracorporeal treatment for severe cases, as outlined in the 2015 systematic review and recommendations from the EXTRIP workgroup 1. The effects of an aspirin overdose can be severe and potentially fatal, with symptoms including ringing in the ears, nausea, vomiting, rapid breathing, confusion, seizures, and in severe cases, coma.
- The toxic dose of aspirin varies but generally exceeds 150 mg/kg body weight.
- Aspirin overdose disrupts the body's acid-base balance, affects multiple organ systems, and can cause potentially fatal complications, including cerebral edema and respiratory failure.
- Children are particularly vulnerable to aspirin toxicity and can develop Reye's syndrome, a rare but serious condition. Key considerations in managing aspirin overdose include:
- Activated charcoal to prevent further absorption if the overdose was recent
- Intravenous fluids
- Possibly hemodialysis in severe cases, as recommended by the EXTRIP workgroup 1 It is essential to prioritize prevention by keeping medications out of reach of children, using child-resistant containers, and carefully following dosing instructions for all medications containing aspirin or other salicylates. In cases of suspected aspirin overdose, it is crucial to call emergency services or poison control immediately, as timely treatment can significantly impact outcomes and reduce the risk of morbidity and mortality.
From the FDA Drug Label
Stop use and ask a doctor if an allergic reaction occurs. 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, pain get worse or lasts more than 10 days, fever gets worse or lasts more than 3 daysredness or swelling is present, new symptons occurringing in the ears or a loss of hearing occurs. The FDA drug label does not answer the question.
From the Research
Effects of Acetylsalicylic Acid (Aspirin) Overdose
The effects of an aspirin overdose can be severe and varied. According to the studies, the following effects have been observed:
- Mild toxicity, including nausea, vomiting, tinnitus, or hyperventilation, which occurred in 22 patients with a median dose of 160 mg/kg 2
- Moderate toxicity, including acid-base disturbance and confusion, which occurred in 16 patients with a median ingested dose of 297 mg/kg 2
- Severe coagulopathy, which was the sole manifestation of aspirin toxicity in one case report, with no other typical symptoms of salicylate toxicity 3
- Death, despite aggressive treatment, including hemodialysis, in one case report 4
Treatment and Management
The treatment and management of aspirin overdose can vary depending on the severity of the overdose and the patient's condition. The following treatments have been used:
- Activated charcoal, which decreased the median peak salicylate concentration in one study 2
- Bicarbonate, which enhanced elimination in one study 2
- Hemodialysis, which was used in one case report, but was not effective in preventing death 4
- Urinary alkalization, which was used in one case report, and was associated with a shorter apparent elimination half-life of salicylate 5
- Correction of hypokalemia, which is recommended in patients with impaired renal function 5
- Repeated doses of charcoal, which may be a worthwhile intervention when there is no risk of aspiration 5
Variability in Treatment Recommendations
There is considerable variability in the recommendations for gastrointestinal decontamination in cases of aspirin overdose, with different poison control centers and toxicologists recommending different courses of action 6. It is essential to monitor the implementation of available guidelines and to consider the possibility of aspirin toxicity in patients with coagulopathy, especially those who are regularly consuming aspirin 3.