Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
J Med Toxicol. 2022 Jan;18(1):30-37. doi: 10.1007/s13181-021-00865-0. Epub 2021 Nov 29.
Aspirin overdose causes acid-base disturbances and organ dysfunction. Management is guided by research reported over 50 years ago when chronic aspirin toxicity was common and accounted for significant morbidity. We investigate our experience of aspirin overdose and the effectiveness of charcoal and bicarbonate administration over 20 years.
This is a retrospective series of acute aspirin overdose from two toxicology units from January 2000 to September 2019. Acute aspirin ingestions > 3000 mg were identified in each unit's database. Excluded were cases of chronic exposure, hospital presentation > 24 hours after ingestion, and cases without a salicylate concentration. Included in our analysis was demographic data, clinical effects, investigations, complications, and treatment.
There were 132 presentations in 108 patients (79 females (73%)). The median age was 28 years (range: 13-93 years). The median dose ingested was 7750 mg (IQR: 6000-14,400 mg). There were 44 aspirin-only ingestions. Mild toxicity (nausea, vomiting, tinnitus or hyperventilation) occurred in 22 with a median dose of 160 mg/kg. Moderate toxicity (acid-base disturbance, confusion) occurred in 16 with a median ingested dose of 297 mg/kg. There were no cases of severe toxicity (coma or seizures) due to aspirin alone. The median peak salicylate concentration was 276 mg/L (IQR: 175-400 mg/L, range: 14-814 mg/L). There was a moderate association between dose ingested and peak concentration (Pearson r = 0.58; 95% CI 0.45-0.68). Activated charcoal was administered in 36 (27%) cases, which decreased the median peak salicylate concentration (34.2 to 24.8 mg/L/g (difference: 9.4, 95% CI: 1.0-13.1)). Bicarbonate was administered in 34 (26%) presentations, decreasing the median apparent elimination half-life from 13.4 to 9.3 h (difference: 4.2 h, 95% CI: 1.0-6.5 h).
Acute aspirin overdose caused only mild to moderate effects in this series. Early administration of activated charcoal decreased absorption and use of bicarbonate enhanced elimination.
阿司匹林过量会导致酸碱平衡紊乱和器官功能障碍。当慢性阿司匹林中毒很常见并导致严重发病率时，研究报告指导了管理。我们调查了我们在过去 20 年中对阿司匹林过量的经验以及活性炭和碳酸氢钠给药的效果。
这是两个毒理学单位从 2000 年 1 月至 2019 年 9 月的急性阿司匹林过量的回顾性系列。在每个单位的数据库中确定了急性摄入> 3000mg 的阿司匹林。排除慢性暴露、摄入后 24 小时以上就诊以及无水杨酸盐浓度的病例。我们的分析包括人口统计学数据、临床效果、检查、并发症和治疗。
108 例患者中有 132 例（79 名女性（73%））出现临床表现。中位年龄为 28 岁（范围：13-93 岁）。中位摄入剂量为 7750mg（IQR：6000-14400mg）。有 44 例仅摄入阿司匹林。22 例出现轻度毒性（恶心、呕吐、耳鸣或过度通气），中位剂量为 160mg/kg。16 例出现中度毒性（酸碱平衡紊乱、意识混乱），中位摄入剂量为 297mg/kg。没有因单独摄入阿司匹林而导致严重毒性（昏迷或癫痫发作）的病例。中位峰水杨酸盐浓度为 276mg/L（IQR：175-400mg/L，范围：14-814mg/L）。摄入剂量与峰浓度之间存在中度相关性（Pearson r=0.58；95%CI 0.45-0.68）。在 36 例（27%）患者中给予活性炭，降低了中位峰水杨酸盐浓度（34.2 至 24.8mg/L/g（差异：9.4，95%CI：1.0-13.1））。在 34 例（26%）表现中给予碳酸氢钠，将中位表观消除半衰期从 13.4 小时缩短至 9.3 小时（差异：4.2 小时，95%CI：1.0-6.5 小时）。
在本系列中，急性阿司匹林过量仅引起轻度至中度影响。活性炭的早期给药减少了吸收，碳酸氢钠的使用增强了消除。
