About Aspirin Poisoning or Salicylate Poisoning:
Aspirin is acetylsalicylic acid and the most widely used drug in the last century. Aspirin is absorbed from the stomach and small intestines and can freely cross the placenta and excreted by urine. It is rapidly converted in the body to salicylic acid which is responsible for most of the actions. Aspirin poisoning or Salicylate Poisoning is more commonly seen in children. Whereas mortality rate in adults is quite low.
Causes of Aspirin Poisoning or Salicylate Poisoning:
Aspirin poisoning or Salicylate Poisoning is not a common phenomenon and can occur due to the following reasons as stated below:-
Attention Seeking Behaviour: People suffering from the urge of gaining unwanted attention of attention deficit syndromes might overdose on aspirin for attention purpose.
Suicidal Tendencies: Aspirin poisoning or salicylate poisoning is common among people with suicidal tendencies who tend to do it in order to commit suicide.
Accidental Ingestion in Children: In rare case scenarios, some cases have been reported for child abuse and misbehaviour. The most common cause of aspirin poisoning or salicylate poisoning is being accidental ingestion in children when they just swallow or ingest the drug thinking of it as a candy.
In Adults: In adults, aspirin poisoning or salicylate poisoning may occur due to relative poisoning strategies or medicinal overdose. In many cases, over the counter prescriptions of aspirin are sold, this leads to its unintentional poisoning as people may take it or consume it in harmful combination that might lead to toxicity and death of body’s tissue and prove to be fatal to aperson.
Body Metabolism: In rare cases, aspirin poisoning or salicylate poisoning can occur by the use of the drug at normal levels or doses. This usually occurs due to the difference in expression and activity of certain enzymes and various metabolites that are synthesized in our body, it can also occur due to alteration in pathways and variations in body metabolism and responses.
- Any other mutational variation can also lead to aspirin poisoning.
- The fatal or life-threatening dose in adults is about fifteen to thirty grams (15-30 gm), but the dose of poisoning is relatively lower at about ten grams.
- Serious toxicity can be seen when body’s serum salicylate levels reach about or more than 50 mg per dL (>50 mg/dl).
Risk Factors For Aspirin Poisoning or Salicylate Poisoning:
Various factors for aspirin poisoning include the following:
Medical Conditions: Aspirin is contraindicated in patients who are sensitive to it and in peptic ulcer, bleeding tendencies, in children suffering from chickenpox or influenza. So any accidental consumption may lead to its toxic effects and cause severe acute Aspirin Poisoning or Salicylate Poisoning.
Due to the risk of Reye’s syndrome, pediatric formulations of aspirin are prohibited in India and the UK. So aspirin acts as a poisonous agent in children.
In Chronic Liver Disease: Cases of hepatic necrosis have been reported
Consumption of aspirin in any form by diabetics and patients with low cardiac reserve or suffering from frank Congestive Heart Failure and juvenile rheumatoid arthritis may lead to its toxicity and cause harmful effects.
Surgery: Aspirin should be stopped 1 week before elective surgery as it may lead to excessive bleeding.
Pregnancy: When aspirin is given during pregnancy, it may be responsible for low birth weight babies. Delayed or prolonged labour, greater postpartum blood loss and premature closure of ductus arteriosus are possible if aspirin is taken. It should be avoided during breastfeeding as it may lead to poisoning in babies due to the accumulation of aspirin in child due to transfer through breast milk.
Genetic Factors: Aspirin can lead to poisonous effects in people suffering from G6PD deficiency syndrome.
Mechanism of Aspirin Poisoning or Salicylate Poisoning:
Aspirin poisoning is said to occur in various phases in our body and these can be explained as follows:-
Phase 1 of Aspirin Poisoning or Salicylate Poisoning:- First is the phase of respiratory alkalosis and it occurs due to excessive excretion of potassium from our bodies and also includes excretion of sodium bicarbonate ions. This phase does not extend for more than twelve hours.
Phase 2:- This phase of Aspirin Poisoning or Salicylate Poisoning usually lasts up to twenty-four hours and is called metabolic acidosis. It may begin as early as 4-5 hours and includes the initial signs and symptoms.
Signs And Symptoms Aspirin Poisoning or Salicylate Poisoning:
In case of aspirin poisoning, the following signs and symptoms is observed. These include:-
Early Signs of Aspirin Poisoning or Salicylate Poisoning:-
As soon as the dose is ingested, early manifestations set it. These include the following: –
- Excessive nausea
- Recurrent vomiting
- Double vision
- Unsteady walking
- Temperature fluctuation.
- There is a sudden dull aching abdominal pain that intensifies with time.
- Ringing in ears
- In severely overdosed patient there may occur aloss of consciousness and mental impairment.
Advanced Signs of Aspirin Poisoning or Salicylate Poisoning:
After twelve to twenty-four hours of aspirin poisoning, the patient develops the following symptoms:-
- Liver Pathology. Their starts occurring liver damage and liver cell death it usually involves the central lobe of the liver first.
- Kidney Pathology. The patient starts developing areduction in glomerular filtration rate this also increases its toxicity as aspirin is mainly excreted in urine. Damage to kidney cells, tissues and tubules start and this leads to reduction and damage of kidney function. Person may land up into acute kidney failure.
- A person suffering from Aspirin Poisoning or Salicylate Poisoning tends to develop metabolic acidosis and alkalosis.
- Low blood potassium
- Low blood glucose
- Cerebral edema
- A cardiopulmonary arrest can occur in cases of serious aspirin poisoning.
- Pulmonary edema.
Diagnosis of Aspirin Poisoning or Salicylate Poisoning:
Diagnosis and suspicion of aspirin poisoning can be done by:-
Any person who has been on prolonged medication of any drug that combines aspirin or has any contents of aspirin in it, when him or her begins to experience certain signs and symptoms like ringing sensations in the ear (tinnitus), agitation, fever, restlessness etc they should immediately consult the doctor.
When any of the danger signs as stated above or some like wheezing, loss of consciousness, bleeding, low blood pressure etc occurs patients should be immediately be rushed to the hospital.
Tests and Examination for Confirming Aspirin Poisoning or Salicylate Poisoning:
Once the local physical examination has been done by the doctor and all the signs and symptoms have been checked, various biochemical and pathological examinations can be performed on the patients. These include:-
A blood test can be done. It tells us about the level of salt salicylate in patient’s blood and helps in knowing the form of medication that has been taken by the patients. Some patients might have taken coated medications hence they are slowly released in the body and the concentration increases after sometime leading to more severe toxicity and increase the levels of salicylate.
- Serum calcium, serum potassium, serum sodium levels are analyzed.
- Basic routine kidney function tests and liver function tests are performed.
- Body’s ph is measured.
- Acid-base metabolism and balance are checked.
Treatment of Aspirin Poisoning or Salicylate Poisoning:
If a patient does not shows any signs and symptoms of poisoning he should be taken care at home and asked not to panic. In case of severe Aspirin Poisoning or Salicylate Poisoning, the person should immediately call the ambulance or rush to an emergency as soon as possible. Vomiting should not be induced in cases of loss of consciousness or altered sensorium as it may cause further discomfort to the patient.
The attendant should be well aware of the patient, his or her name, age, job or occupation, any course of treatment that required the use of aspirin or any other drugs, how many medications the patient took or any treatment tried at home later. The attendant should be well versed and answer all the questions of the doctor carefully and honestly. The doctors should be informed about any prior medical condition of the patient before starting the treatment for Aspirin Poisoning or Salicylate Poisoning in order to avoid future complications.
Medications & Treatment Protocol:
In order to prevent the further complications arising out of Aspirin Poisoning or Salicylate Poisoning, activated charcoal is given. Activated charcoal (more preferred as it is aspirated less than gastric lavage) is given to the person as it is the most commonly used method and helps in reducing the contamination by absorption of the gastric content and paracetamol present in the stomach.
Gastric lavage that is emptying the contents of the bowel from the mouth by Ryle’s tube should be carried out immediately on reaching the hospital. Gastric lavage is done to remove the unabsorbed drug.
Forced alkaline diuresis or haemodialysis to remove absorbed drug is indicated in severe cases of Aspirin Poisoning or Salicylate Poisoning where ingestion is more than more than 50 mg per dL (>50 mg/dL). Hemodialysis helps in retaining back the kidney function and restoring the normal electrolyte balance and urine output. Hence helps in decreasing the toxicity.
Blood transfusion and vitamin K is given if bleeding occurs.
Dextrose and sodium bicarbonate are given to maintain the urinary output so as to excrete the toxic substances. Most important is external cooling and intravenous fluid with sodium (Na), potassium (K), bicarbonate (HCO3) and glucose are given according to need to be determined by repeated monitoring
Intubation, that is an external support for breathing, can be introduced in patients with severe aspirin poisoning or salicylate poisoning. Some people may also go on or require a ventilator.
Catheterization of the bladder is recommended so as to monitor the amount of urine that is being excreted by our body. It helps in determining kidney’s function and salicylate level.
Symptomatic medications are given for the symptoms like nausea vomiting or seizures. NSAID etc are given or started mostly intravenous.
Prevention of Aspirin Poisoning or Salicylate Poisoning:
Various practices and methods can be adapted in our society to reduce the chance of aspirin poisoning or Salicylate Poisoning. These include the following:-
- Replacement of aspirin with other drugs and newer drugs that have less of the side effects and reduced tendencies of bleeding.
- The easy availability of the drug should be reduced and should be monitored over the counter. Any misuse of drug and purchase of the drug on large scale purchase should be cross-checked.
- Ideally, the aspirin should not be given without any authorized medical prescription hence it leads to decrease in a number of cases. This practice has been started by many European countries and states and is followed strictly.
- Any suspected or reported case of aspirin poisoning or overdosing should be immediately brought to the hospital without delay.
- Aspirin can be combined with other drugs that can help it to reduce its toxic effects and cause less harm in the long run to the patient.
- The patient should be advised to take only the prescribed amount of aspirin dose not more than that ever.
- In cases of suicide attempt by way of Aspirin Poisoning or Salicylate Poisoning, psychiatric follow up is recommended and close ones are told to be always near the victim so as to avoid such cases again in future.