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Salicylate (aspirin) poisoning in adults

Authors
Edward W Boyer, MD, PhD
Kathryn W Weibrecht, MD
Section Editor
Stephen J Traub, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

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 [1]. 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 "Benefits and risks of aspirin in secondary and primary prevention of cardiovascular disease".)

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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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 30 00:00:00 GMT+00:00 2016.
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