From the Guidelines
For treating aspirin overdose, activated charcoal should be administered as soon as possible, ideally within 1-2 hours of ingestion, though it may still be beneficial up to 4 hours post-ingestion or longer in cases of massive overdose. The recommended dose is 1 g/kg body weight (typically 50-100 g for adults) 1. Activated charcoal can be given with or without sorbitol, but single-dose charcoal without sorbitol is generally preferred for aspirin overdose. If sorbitol is used (to promote catharsis), it should be limited to the first dose only at 1-2 g/kg, with caution in children and elderly patients due to dehydration risk. Multiple doses of activated charcoal (without sorbitol) may be beneficial for severe aspirin toxicity, given every 4-6 hours at half the initial dose, as this enhances aspirin elimination through "gut dialysis" by interrupting enterohepatic circulation. This approach is particularly important because aspirin can form concretions in the stomach, leading to delayed absorption. Other critical treatments include IV fluids, urinary alkalinization, and close monitoring of vital signs, mental status, and electrolytes, with hemodialysis reserved for severe cases, as indicated by the Extracorporeal Treatment for Salicylate Poisoning recommendations 1. Key considerations for hemodialysis include severe poisoning, altered mental status, acute respiratory distress syndrome, or failure to respond to standard therapy, with a recommended threshold for extracorporeal treatment at a salicylate concentration greater than 7.2 mmol/L (100 mg/dL) after acute salicylate poisoning 1. Given the potential for severe outcomes, timely involvement of a clinical toxicologist is advisable in all cases of aspirin overdose.
From the Research
Treatment of Aspirin Overdose with Charcoal
- Activated charcoal can be used to treat aspirin overdose by reducing the absorption of aspirin in the gut 2, 3, 4, 5.
- The effectiveness of activated charcoal in reducing aspirin absorption is supported by several studies, including one that found a significant decrease in salicylate excretion when activated charcoal was administered after aspirin ingestion 3.
- Another study found that early administration of activated charcoal decreased the median peak salicylate concentration in patients with acute aspirin overdose 4.
Use of Sorbitol with Charcoal
- Sorbitol is a cathartic that can be used in combination with activated charcoal to enhance the elimination of aspirin from the body 5.
- However, the use of sorbitol with charcoal is not universally recommended, and some studies suggest that activated charcoal alone may be sufficient to reduce aspirin absorption 3, 4.
- One study found that the combination of ipecac and activated charcoal/MgSO4 was not more effective than activated charcoal/MgSO4 alone in reducing aspirin absorption, and that the use of ipecac may actually decrease the effectiveness of activated charcoal due to vomiting 5.
Administration of Charcoal
- Activated charcoal can be administered at different times after aspirin ingestion, and its effectiveness may vary depending on the timing of administration 6.
- One study found that preadministration of activated charcoal 30 or 60 minutes before aspirin ingestion had little effect on aspirin absorption, suggesting that charcoal is most effective when administered after aspirin ingestion 6.
- Another study found that early administration of activated charcoal after aspirin overdose was effective in reducing the median peak salicylate concentration and enhancing the elimination of aspirin from the body 4.