Aspirin Poisoning

Aspirin Poisoning Overview

Aspirin is another name for acetylsalicylic acid, a common pain reliever (also called an analgesic). The earliest known uses of the drug can be traced back to the Greek physician Hippocrates in the fifth century BC. He used powder extracted from the bark of willows to treat pain and reduce fever.

Aspirin Poisoning Causes

For a variety of reasons, some people intentionally ingest poisons or poison others. Some reasons include:

Aspirin poisoning can also be accidental and was once the most common cause of accidental poisoning of children. Safety precautions such as child-resistant packaging has helped make it less common.

Inappropriate dosing in both children and elderly people is one of the reasons accidental aspirin poisonings continue to happen. Hundreds of medications -- both over-the-counter and prescription medicines -- contain aspirin or aspirin-like substances. Unintentional poisoning can result if these medications are taken in combination, in inappropriate doses, or over a long time period. This is especially likely to occur in older people with chronic health problems.

Aspirin Poisoning Symptoms

The earliest symptoms of acute aspirin poisoning may include ringing in the ears (tinnitus) and impaired hearing. More clinically significant signs and symptoms may include rapid breathing (hyperventilation), vomiting, dehydration, fever, double vision, and feeling faint.

Later signs of aspirin poisoning, or signs of more significant poisoning, can include drowsiness or confusion, bizarre behavior, unsteady walking, and coma.

The abnormal breathing caused by aspirin poisoning is usually rapid and deep. Vomiting may occur 3-8 hours after taking too much aspirin. Serious dehydration may occur from hyperventilation, vomiting, and fever.

When to Seek Medical Care

If you have been taking aspirin and begin to have ringing in your ears, call your doctor to see if the medication should be stopped or the dosage reduced..

For all other symptoms, call 911 (or the local emergency phone number) immediately. Serious symptoms include the following:

Exams and Tests

The doctor will take a history and perform a physical examination to look for evidence of poisoning. The doctor will order laboratory tests to look for damage to organ systems that can be harmed by aspirin overdose and, depending on the timing, also to check for the level of aspirin in the bloodstream.

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The doctor will make sure you are able to breathe and will check vital signs including body temperature. The doctor will check alertness by asking you to respond to questions. If you are unconscious, the doctor will give oxygen and perhaps use machines to help you breathe.

Blood will be taken for lab testing. One blood test will measure the amount of salicylate, the active ingredient in aspirin, in your blood. Sometimes the blood level of salicylate can increase over time even though an individual has not taken any more aspirin. This may indicate the person has taken coated tablets or sustained-release tablets, which release salicylate into the bloodstream slowly.

The doctor will make treatment decisions based on the dose of active ingredient ingested, the time over which it was ingested, your age, the symptoms you are experiencing, and your acid-base status. Acid-base status is the balance of acid and base in the blood. Aspirin may change this balance quickly, so the doctor will monitor this to guide treatment.

Aspirin Poisoning Treatment - Self-Care at Home

Call 911 immediately if a drug overdose is discovered or suspected, and the victim is unconscious, having convulsions, not breathing, or is otherwise seriously ill.

If the person who took the aspirin is not having symptoms, do not wait to see if symptoms develop. Call the local poison control center immediately. It is a good idea to post the telephone number of the local poison control center near the phone. This information can be found at: American Association of Poison Control Centers. Or call (800) 222-1222 if you have a poisoning emergency.

Providing as much information as possible to the poison control center can help determine what the next course of action should be. The poison control center, paramedics, and emergency department staff will want the following information:

  • Is the person conscious?
  • Is the person breathing?
  • What medications were taken? Try to locate the medicine container.
  • What is the medicine's name and how many milligrams (mg) is each pill?
  • How much of the medicine did the person take and when was it taken?
  • Was the medicine taken with alcohol or any other drugs or chemicals?
  • How old is the person who took the medicine?
  • What are the current symptoms?
  • What medical conditions does the person have?

Although ipecac syrup was used in the past to make the victim vomit, it is rarely recommended today and is not usually appropriate in aspirin poisoning. Causing vomiting can be very dangerous in the case of an altered mental status or convulsions.

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Medical Treatment

Doctors may use gastric lavage, or pumping out the stomach contents, to try to prevent further absorption of the aspirin into the body. Dialysis is also sometimes used to reduce the amount of salicylate in the body.

Medications

Activated charcoal: To prevent more absorption, the doctor may give activated charcoal to absorb the salicylate from the stomach. A laxative may be given with the activated charcoal to move the mixture through the gastrointestinal system more rapidly. People who have been severely poisoned may be given repeated doses of activated charcoal.

IV fluids: Dehydration occurs early in aspirin poisoning. To correct dehydration, the doctor will start an IV to provide fluids. The doctor will also work to correct imbalances in the body's blood chemistries.

Alkaline diuresis: This is a way to reduce the amount of salicylate in the body. Alkaline diuresis is the process of giving a person who has been poisoned compounds that alter the chemistry of the blood and urine in a way that allows the kidneys to remove more salicylate. Specifically, sodium bicarbonate is given via IV to make the blood and urine less acidic (more alkaline). This encourages the kidneys to capture more salicylate that can leave the body through the urine. Sometimes, other compounds, such as potassium, also have to be given to help with this process.

Other Therapy

The emergency physician may have to perform other procedures or give other medications as supportive care in the case of a dangerous aspirin overdose. These actions may include the following:

  • Placing a breathing tube (intubation) and assisting breathing with a ventilator for a person who is in a coma, cannot protect his or her own airway, or needs mechanical breathing
  • Placing of a catheter into the bladder to monitor urine output and frequently check the acidity (pH) of the urine
  • Giving other medicines as needed to treat agitation, convulsions (seizures), or other complications of aspirin poisoning

Next Steps

  • A person with serious symptoms may be admitted to an intensive care unit.
  • If the overdose was intentional, psychiatric services should be provided.
  • A person with minor symptoms such as ringing in the ears or nausea may be admitted to the hospital for further observation.

The following people, will likely be admitted to the hospital regardless of salicylate levels:

  • Infants and elderly persons
  • People with long-term salicylism
  • People who ingested sustained-release products

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Follow-up

  • Psychiatric and medical follow-up may be recommended.
  • Careful monitoring of medication will also be recommended.
  • Tests to monitor kidney function may be done periodically after hospital discharge, especially in elderly people.

Prevention

  • Prescription medications should be used according to your doctor's and pharmacist's directions.
  • Never take a medicine prescribed for someone else.
  • To protect children from accidental drug overdose, all medications should be stored in containers with child-resistant caps. All medications should be out of sight and out of reach of children, preferably in a locked cabinet.
  • Take suicidal threats seriously.
  • Never give or take medication in the dark.
  • Always tell the doctor of any previous side effects or adverse reactions to medication as well as any new or unusual symptoms that occur.
  • Never take more than the recommended or prescribed dose of a medication.
  • Inform your doctor about all the medications you are taking. Be sure to mention over-the-counter medications.

Outlook

Recovery is likely if the proper treatment is given and the dose of aspirin taken is not too high.

With chronic aspirin poisoning outcomes are less predictable.

With acute aspirin poisoning, severity and outcome depend on many factors including the dose taken and the person's body weight.

For More Information - Web Links

American Association of Poison Control Centers

Synonyms and Keywords

aspirin poisoning, aspirin overdose, aspirin toxicity, salicylate poisoning, ASA, analgesic, acetylsalicylic acid, poisoning, drug overdose, medication overdose, signs of aspirin poisoning, signs of aspirin overdose

WebMD Medical Reference Reviewed by Carol DerSarkissian on July 30, 2018

Sources

SOURCES:

eMedicineHealth: "Aspirin Poisoning." 

Children's Hospital of Philadelphia Poison Control Center: "Aspirin: The Basics."

UpToDate: "Salicylate (aspirin) poisoning in adults."

American Association of Poison Control Centers.

MedlinePlus: "Aspirin overdose."

 

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