Salicylate (aspirin) poisoning in adults
- Edward W Boyer, MD, PhD
Edward W Boyer, MD, PhD
- Professor of Emergency Medicine, Director of Toxicology
- University of Massachusetts Medical School
- Kathryn W Weibrecht, MD
Kathryn W Weibrecht, MD
- Emergency Medicine Physician
- Morton Hospital
Aspirin and other salicylates are among the oldest medications remaining in clinical practice. The use of aspirin has declined due to its association with Reye's syndrome in children, and the development of other nonsteroidal antiinflammatory drugs (NSAIDs). However, aspirin remains a common analgesic and a widely prescribed antiplatelet therapy for patients with cardiovascular and cerebrovascular disease, and thus aspirin toxicity remains an important clinical problem . Salicylates are found in a number of medications other than aspirin, including salicylic acid (a topical keratolytic agent and wart remover) and methyl salicylate (Oil of Wintergreen). (See "Aspirin: Mechanism of action, major toxicities, and use in rheumatic diseases" and "Aspirin in the primary prevention of cardiovascular disease and cancer".)
The clinical manifestations and management of all salicylate intoxications are similar. Throughout this section, the terms "aspirin" and "salicylates" will be used interchangeably.
The management of salicylate intoxication will be reviewed here. A summary table to facilitate emergent management is provided (table 1). Aspirin poisoning in children and general issues relating to the clinical management of drug intoxication are presented separately. (See "Salicylate poisoning in children and adolescents" and "General approach to drug poisoning in adults" and "Gastrointestinal decontamination of the poisoned patient".)
MECHANISM OF ACTION
Aspirin has multiple cellular and systemic effects [2-4]:
●Inhibition of cyclooxygenase results in decreased synthesis of prostaglandins, prostacyclin, and thromboxanes. This contributes to platelet dysfunction and gastric mucosal injury.
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- MECHANISM OF ACTION
- ABSORPTION AND METABOLISM
- CLINICAL FEATURES OF ACUTE OVERDOSE
- Vital signs
- Nausea and vomiting
- Acid-base abnormalities
- Alterations in mental status
- Pulmonary edema
- Hepatic effects
- DIAGNOSTIC TESTING
- Serum salicylate
- Coagulation studies
- Anion gap
- Imaging studies
- CHRONIC SALICYLATE POISONING
- Airway and breathing
- Supplemental glucose
- Alkalinization of serum and urine
- Repeat laboratory testing
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS