Absorption of large, potentially lethal doses may be much slower than absorption of therapeutic doses, particularly due to salicylate-induced gastroparesis. 14 The toxic effects of ASA, methyl salicylate, and sodium salicylate are qualitatively identical, so the following discussion applies to poisoning with any of these agents. 11-13 There is a case report of a newborn with ichthyosis who was treated with twice-daily topical 20% salicylate ointment from day 1 through the 9th day of life who developed salicylate toxicity (salicylate level on day 7 was 119 mg/dL).
Aspirin overdose antidote skin#
Significant amounts of salicylates typically are not absorbed through the skin except in select patients, such as children and patients with compromised skin such as burn patients and those who apply salicylate medications to large surface areas. 10 Dermal salicylate formulations typically do not result in tissue penetration much deeper than 4 mm in human volunteer experiments. There is a case report describing a 4-year-old who died after ingesting 3 ounces of Pepto Bismol. Bismuth subsalicylate (Pepto Bismol), an over-the-counter preparation containing up to 236 mg/15 mL of salicylate, is used in the treatment of diarrhea and prophylaxis for traveler's diarrhea. A potentially lethal dose for a 2-year-old child is one teaspoon (5 cc) containing the equivalent of 6.9 grams of aspirin or almost 22 adult aspirin tablets. The severe toxicity of this agent is related to its high salicylate content. 7-9 Methyl salicylate (oil of wintergreen), generally meant for topical application, causes a disproportionately high number of salicylate poisoning deaths when ingested or used topically in excess. The purpose of this paper is to review the pathophysiology and management of salicylate poisoning that is of concern to the practicing emergency physician.Īlthough aspirin is the most common cause of salicylate poisoning, several compounds can cause similar toxic manifestations. 4-6 Therefore, in the face of dehydration and decreased glomerular filtration, drug clearance is impaired. Also, much of the aspirin elimination is through urinary excretion of unchanged drug. As serum salicylate concentrations increase, the ability of the liver to metabolize the drug diminishes until predictable, first-order elimination kinetics (excretion is proportional to the salicylate concentration) are replaced by unpredictable, dose-dependent, zero-order (metabolic rate is constant) elimination. The primary factor is aspirin's elimination pattern. There are several factors that work in concert to make chronic salicylate intoxication so common. Salicylism is the result of acute ingestion in about 60% of cases and chronic ingestion in the remaining 40%. It is estimated that the use of child-resistant packaging for salicylate-containing medications has resulted in a 34% reduction in the salicylate-related child mortality rate. This decrease may be due to the fact that pediatricians currently prefer acetaminophen/ibuprofen preparations, and the FDA limits baby ASA bottles to 36 tablets per bottle and mandates child-resistant caps. 1,2 Poison control surveillance data now rank salicylate poisoning as the 13th most common fatal ingestion.
Although historically aspirin has been the most common cause of poisoning and death in children younger than 5 years of age, the incidence of salicylate overdose during the past two decades has significantly decreased. Aspirin may be found in combination with other agents such as narcotics, barbiturates, and caffeine. Salicylate poisoning remains a major clinical problem involving accidental ingestion in children and intentional overdose in adults. Velez, MD, Associate Professor and Associate Residency Director, Division of Emergency Medicine, University of Texas Southwestern Medical Center Staff Toxicologist, North Texas Poison Center, Dallas. Lampell, MD, Associate Professor, Pediatric Emergency Medicine, University of Rochester, NY. This article will serve as a comprehensive review of this "old" ingestion. Treatment can be tricky and falls to the emergency physician to initiate. The presence of an unexplained acid-base abnormality may be the only clue. At times the diagnosis is not apparent, especially when aspirin is taken as part of a multi-drug ingestion. While there are many other pain relief products on the market, and aspirin is generally avoided in children, aspirin overdose remains a serious problem. Aspirin overdose may be thought by some to be an "old" problem.
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