Adult Aspirin = 5 gr (325 mg)
Baby Aspirin = 1.2g gr (81 mg)
Methylsalicylate --1 tsp (100% MS) = 21 Adult Strength Aspirin
Salicylate Product Strengths
Salicylates are present in aspirin medications, Pepto-Bismol® and in high concentrations of oil of wintergreen (methyl salicylate: 1 teaspoon = 7 g of salicylate).
What products are salicylates found in?
Toxic Dose of ASA
Minimal Lethal dose of ASA
In children = 4cc of a 100% solution
In adults = 6 cc of a 100% solution
Lethal Dose of Methylsalicylate
-- Renal Function
What factors influence salicylate toxicity?
Hyperventilation (30 minutes)
Metabolic Acidosis (12-24 hrs)
What are the manifestations of salicylate poisoning?
Complications of salicylate (ASA) poisoning are:
150 mg/Kg -----> No toxicity Expected
150 - 300 mg/Kg -----> Mild to Moderate toxicity Expected
300 - 500 mg/Kg -----> Life Threatening Toxicity Expected (Severe, possibly fatal)
Assessing Salicylate Poisoning Dose:
Symptoms expected with MILD toxicity:
Symptoms expected with MODERATE toxicity:
Symptoms expected with SEVERE Toxicity:
Coags - PT/INR
Quantitative ASA lvsl q 2 hrs until peaks and see level consistently falling.
Renal Function tests
Labs for assessing salicylate poisoning:
-- May occur when >100mg/Kg/day ingested for 2 or 3 days
-- Severe CNS symptoms, dehydration, hyperventilation
-- ASA lvl of no prognostic value
CHRONIC salicylate (ASA) ingestion:
-- AC and cathartic
-- MDAC for asa lvls that continue to rise or for ingestion of enteric coated asa (risk for bezoars)
-- Alkaline Diuresis (bicarb gtt w/ potassium supplementation to prevent hypokalemia)
-- Fluid/Electrolyte Management
-- alkalization/diuresis for a urine pH of 7.5-8.0
-- aggressive re-hydration
-- sponge baths, fans, cold water submersion
How to Manage ASA/Salicylate Toxicity:
Salicylate Level > 50 mg% accompanied by symptoms and biochemical abnormalities.
What are the indications for Alkaline Diuresis?
Alkalosis, hypernatremia, fluid overload, decreased ionized CA++ and tetany.
What are the risks with Alkaline Diuresis?
What is the treatment of choice for severe asa poisoning?
A Plasma concentrations greater than 700 mg/L (5.1 mmol/L)
Congestive cardiac failure
Non-cardiogenic pulmonary edema
CNS effects not resolved by correction of acidosis
Persistently high salicylate concentrations unresponsive to urinary alkalinization
Severe metabolic acidosis (pH below 7.2)
What are the indications for hemodialyis in ASA toxicity?
Children and the elderly
Pulmonary edema, central nervous system (CNS) features, hyperpyrexia
Salicylate concentration above 700 mg/L (5.1 mmol/L)
What are risk factors for death in salicylate poisoning?
> 350 mg/L (2.5 mmol/L).
Salicylate intoxication is usually associated with what level ASA concentration?
exceed 700 mg/L (5.1 mmol/L).
Most adult deaths occur in patients whose asa concentrations ...
those under 10 years or over 70 years
Patients in what age group have an increased risk of salicylate toxicity and may require dialysis at an earlier stage?
delayed absorption and toxicity
The development of bezoars in asa toxicity can result in what?
Case Study for Review