From the Guidelines
Treating an aspirin overdose requires immediate medical attention, and extracorporeal treatment, such as hemodialysis, is recommended in severe cases, including altered mental status, acute respiratory distress syndrome, and high salicylate concentrations (>7.2 mmol/L [100 mg/dL]) 1. The management of aspirin overdose involves several key steps to minimize morbidity and mortality.
- Activated charcoal (usually 50-100 grams for adults) may be administered to prevent further absorption of the drug if the overdose was recent.
- In severe cases, healthcare providers may perform gastric lavage (stomach pumping) and administer intravenous fluids to correct electrolyte imbalances and enhance aspirin elimination.
- Sodium bicarbonate may be given to alkalinize the urine, which helps the body eliminate aspirin more quickly.
- Hemodialysis might be necessary in life-threatening cases or when blood aspirin levels are extremely high, as it can efficiently reduce the burden of circulating salicylate and correct acidemia 2. While waiting for emergency services, do not induce vomiting unless specifically instructed by poison control. Aspirin overdose is dangerous because it disrupts the body's acid-base balance, affects multiple organ systems, and can cause symptoms ranging from ringing in the ears and rapid breathing to seizures and coma. The severity depends on the amount ingested and the time since ingestion, which is why prompt medical treatment is essential. Extracorporeal treatment is suggested if the blood pH is less than or equal to 7.20 (2D) or if standard therapy is deemed to be failing 3. Intermittent hemodialysis is the preferred modality, although hemoperfusion and continuous renal replacement therapies are acceptable alternatives if hemodialysis is unavailable 1. It is crucial to consider the patient's kidney function, as impaired kidney function may require a lower threshold for extracorporeal treatment 4.
From the FDA Drug Label
Sodium bicarbonate is further indicated in the treatment of certain drug intoxications, including ... in poisoning by salicylates
- Treatment for aspirin overdose involves the use of sodium bicarbonate to help manage the condition.
- The primary goal is to alkalinize the urine and minimize the risks associated with the overdose.
- Vigorous bicarbonate therapy may be required in severe cases of aspirin overdose, especially if there is a significant risk of metabolic acidosis 5
From the Research
Treatment Options for Aspirin Overdose
- Activated charcoal administration is a common treatment approach, which can decrease the absorption of aspirin and reduce peak salicylate concentration 6, 7.
- Sodium bicarbonate can be used to counteract metabolic acidosis and enhance renal excretion of salicylates 6, 8.
- Hemodialysis (HD) may be considered in severe cases of salicylate intoxication, although the optimal duration and mode of therapy are still debated 9.
- Gastric lavage is not recommended as a primary treatment option due to its limited efficacy, especially if performed late after drug ingestion 8.
Management of Salicylate Intoxication
- Close monitoring of serum electrolytes, blood and urine pH, blood PO2, blood PCO2, and blood HCO3- concentrations is crucial in managing salicylate overdose 10.
- Repeated administration of activated charcoal may enhance non-renal clearance of salicylates 8.
- Glycine may be administered orally to overcome the limited availability of glycine for salicylic acid metabolism in poisoning cases 8.
Important Considerations
- The effectiveness of treatment depends on the severity of the overdose and the timely initiation of treatment 9, 6.
- Patients with severe salicylate poisonings may require extended durations of HD to effectively mitigate toxicity 9.
- Further studies are needed to determine the optimal therapy for severe salicylate intoxications 9, 6.