Aspirin (salicylate) overdose: Lethal poisoning and how to manage it

Aspirin is one of the most dangerous drugs in overdose. Once absorbed it rapidly becomes salicylic acid and causes profound metabolic derangement, neurological compromise, seizures and death.
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Please note, this video is not medical advice
Aspirin causes three sequential changes to the metabolic system:
1) a respiratory alkalosis through direct action of salicylic acid on the medulla
2) a metabolic acidosis with a high anion gap (HAGMA)
3) metabolic acidosis (HAGMA) but without respiratory compensation, or with respiratory acidosis
Due to its low pKa, aspirin is converted to its un-ionised form at an acidic pH. This allows it to cross lipid membranes. The two consequences to this are
a) Crossing into the brain and
b) Being readily re-absorbed in the kidney.
Correcting metabolic acidosis helps reduce neurotoxicity, whilst urine alkalinisation "traps" the drug in the urine and prevents it being reabsorbed.
The main treatments for aspirin poisoning are:
Activated Charcoal (for overdoses seen in the first six hours)
Urine alkalinisation (for most overdoses)
Haemodialysis (for severe overdoses)
Sources used for this video:
Chan TY. The risk of severe salicylate poisoning following the ingestion of topical medicaments or aspirin. Postgrad Med J 1996;72(844):109-12
Dargan PI, Wallace CI, Jones AL An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J 2002;19(3):206-09.
Juurlink DN, Gosselin S, Kielstein JT, Ghannoum M, Lavergne V, Nolin TD, et al. Extracorporeal treatment for salicylate poisoning: Systematic review and recommendations from the EXTRIP Workgroup. Ann Emerg Med 2015;66(2):165-81.
O’Malley GF. Emergency department management of the salicylate-poisoned patient. Emerg Med Clin North Am 2007;25(2):333-46; abstract viii.
Proudfoot AT, Krenzelok EP, Vale JA. Position paper on urine alkalinization. J Toxicol Clin Toxicol. 2004;42(1):1-26.
Therapeutic Guidelines Ltd (eTG March 2021 edition)
tgldcdp.tg.org.au.acs.hcn.com...
Austin Health Clinical toxicology service guideline for Urinary Alkalinisation
www.austin.org.au/Assets/File...
EXTRIP workgroup review and recommendations
pubmed.ncbi.nlm.nih.gov/25986...

[@poptarts1436]

thanks! was trying to understand this concept more clearly since it happened to me in january lol
almost needed dialysis, got up to like 52.8% out of like 90 i think before i went into the icu
got the help i needed so im fine now

[@queentabengwa632]

Thank you so much ..very clear and simple

[@EMMEvideos]

glad you liked it!

[@wroni]

Thanks for the great video! As I cannot find any material on it currently, I’m hoping you can help - are you aware of any papers or info on potential long term effects of salicylate poisoning?

[@EMMEvideos]

Sorry not something I know much about. Most people I have treated have recovered well if they make it thorough the initial few days, the early management is important.

[@pallana3701]

I guess after hearing this it’s true what they say: too much of anything could kill

[@EMMEvideos]

True. Even chocolate unfortunately

[@pallana3701]

@@EMMEvideos 😞 we can’t have nothing 🤷🏼‍♀️

[@user-uj9tr1wz5y]

Thank youu

[@EMMEvideos]

glad you liked it!