Aspirin OD

Question 1

How does aspirin come?

Answer 1

300mg tablet

Question 2

What is an OD amount for aspirin?

Answer 2

OD is > 150mg/kg, severe if >500mg/kg

Question 3

What is important to ask in history for aspirin OD?

Answer 3

1. Amount/preparation of salicylate?
2. Intentional or accidental?
3. Isolated or mixed?

Question 4

What may be found in clinical examination of aspirin OD?

Answer 4

1. Warm peripheries
2. bounding pulse
3. Tachypnoea
4. hyperventilation
5. Cardiac arrhythmia
6. Acute pulmonary oedema

Question 5

What are possible DDx for aspirin OD?

Answer 5

1. Paracetamol OD

2. DKA

Question 6

What can be seen on early presentation for aspirin OD?

Answer 6

1. Tinnitus, deafness, dizziness (aspiringing)
2. Hyperpnoea (rasp-irin)
3. Hyperthermia + sweating (perspiring)
4. N&V, diarrhoea

Question 7

What can be seen on late/server presentation for aspirin OD?

Answer 7

1. Low BP and heart block
2. Pulmonary oedema
3. Low GCS + seizures

Question 8

What beside investigations are used for aspirin OD?

Answer 8

1. ECG
2. CBG
3. ABG

Question 9

Why is an ECG done?

Answer 9

monitor arrythmias

Question 10

Why is a CBG done?

Answer 10

exclude hypgolycaemia or ketoacidosis

Question 11

Why is ABG done?

Answer 11

1. hyperventilation causes initial respiratory alkalosis

2. this progress to high anion gap metabolic acidosis

Question 12

What lab tests are done for aspirin OD?

Answer 12

1. Plasma salicylate concentration
2. Plasma paraceamol conc: mixed OD
3. FBC
4. U+Es
5. LFT
6. Coagulation

Question 13

Why are FBC done?

Answer 13

exclude infectious aietology

Question 14

When is plasma slaicylate conentration done?

Answer 14

at least 2 hours after ingestion, repeat every 2 hours until peak concentration

Question 15

Why are U+Es done?

Answer 15

hyperkalamia is common

Question 16

Why are LFTs done?

Answer 16

hepatic dysfunction

Question 17

Why is coagulation done?

Answer 17

INR and prothrombin time

Question 18

Why is CT head done?

Answer 18

if patient altered statu

Question 19

How is an OD daignosed?

Answer 19

classified, according to peak salicylate levels

Question 20

What is mild toxicity?

Answer 20

<300 mg/L

Question 21

What is moderate toxicity?

Answer 21

300 to 700 mg/L

Question 22

What is severe toxicity?

Answer 22

> 700 mg/L

Question 23

What is the management of aspirin OD?

Answer 23

1. NO antidote – mainly supportive

2. Consider ICU admission for moderate to severe admission

Question 24

How does resp alklaosis turn into met acidosis?

Answer 24

1. Directly stimulates respiratory centre in medulla causing hyperventilation, therefore you get this initial respiratory alkalosis
2. also uncouples oxidative phosphorylation, which sends the body into anaerobic respiration
3. body produces lactic acid sending the respiratory alkalosis, into metabolic acidosis with a high anion gap.

Question 25

Why is there hyperpnoea and hyperthemia in aspirin OD?

Answer 25

1. Hyperpnoea, is caused by the fact that aspirin directly stimulates the respiratory centre in the medulla
2. Hyperthermia and sweating is caused by the uncoupling of oxidative phosphorylation, that sends the body into anaerobic respiration