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TAS Accidents and Poisoning ✅ > Aspirin Poisoning ✅ > Flashcards

Aspirin Poisoning ✅ Flashcards

1
Q

What has happened to the incidence of aspirin poisoning in children?

A

It has become much rarer than it once was

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2
Q

What is the severity of toxicity of aspirin related to?

A

Dosage

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3
Q

What doses of aspirin generally result in only mild toxicity?

A

150mg/kg or less

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4
Q

What are the features of mild aspirin toxicity?

A

Asymptomatic, or only nausea and vomiting

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5
Q

What doses of aspirin are potentially fatal?

A

300mg/kg or more

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6
Q

What symptoms may be produced from doses of aspirin 150-300mg/kg?

A
  • Nausea and vomiting
  • Tinnitus
  • Headache
  • Confusion
  • Fever
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7
Q

What is the use of measurement of plasma salicylate concentration in aspirin poisoning?

A
  • Diagnosis

- Guide to extent of toxicity

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8
Q

What is looked at when using plasma salicylate levels as a guide to extent of toxicity from salicylate poisoning?

A

Peak concentrations

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9
Q

What peak salicylate concentrations are seen in therapeutic doses of aspirin?

A

30-300g/L

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10
Q

What peak salicylate concentrations are seen in aspirin overdose?

A

Greater than 500mg/L

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11
Q

How are peak salicylate concentrations determined in aspirin overdose?

A

Concentrations should be measured 4 hours after ingestion and repeated at 2-hourly intervals to determine peak

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12
Q

Why do you need to keep measuring salicylate levels at 2 hourly intervals to determine peak concentrations in aspirin overdose?

A

Aspirin tablets can form concretions in the stomach leading to delayed absorption

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13
Q

What is classically seen on blood gas in aspirin overdose?

A

Initially respiratory alkalosis, then metabolic acidosis

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14
Q

Why is there classically an initial respiratory acidosis in aspirin overdose?

A

As salicylate directly stimulates the respiratory centre in the pain

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15
Q

Is there always evidence of an initial respiratory alkalosis in salicylate poisoning?

A

No, not always in infants

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16
Q

What causes the metabolic acidosis in aspirin poisoning?

A
  • Uncoupling of oxidative phosphorylation leading to lactic acid accumulation
  • Reduction in ATP production leading to fatty acid oxidation generating ketone bodies
17
Q

What happens to the anion gap in metabolic acidosis caused by aspirin overdose?

A

It is raised

18
Q

How long after ingestion does the metabolic acidosis occur in older children and adults in aspirin poisoning?

A

12-24 hours after ingestion

19
Q

How long after ingestion does the metabolic acidosis occur in aspirin poisoning?

A

4-6 hours

20
Q

What are the treatment options for aspirin poisoning?

A
  • Haemodialysis or diafiltration

- Urinary alkalisation

21
Q

Is haemodialysis/diafiltration effective in removing salicylate from the circulation?

A

Yes, very

22
Q

When should haemodialysis/diafiltration be considered to remove salicylate from the circulation?

A

In all cases of severe or life-threatening toxicity

23
Q

What is the purpose of urinary alkalisation in salicylate poisoning?

A

Enhances the excretion of salicylate

24
Q

When should urinary alkalisation be considered in salicylate poisoning?

A
  • Cases of moderate toxicity

- Whilst awaiting the initiation of extracorporeal methods of elimination

25
Q

How is urinary alkalisation achieved?

A

Administration of significant amounts of sodium bicarbonate intravenously

26
Q

How does urinary alkalisation increase the excretion of salicylates?

A

Salicylates exist as weak acids and are excreted in the urine. Increasing the pH of urine in the renal tubular lumen leads to increased ionisation of salicylates, favouring excretion over passive diffusion back into the blood.

27
Q

By how much is renal salicylate clearance increased with a increase in urinary pH from 5 to 8?

A

10-20x

28
Q

Is forced diuresis needed when urinary alkalisation is used to increase salicylate excretion?

A

No

29
Q

Why is forced diuresis not needed when urinary alkalisation is used to increase urinary salicylate excretion?

A

The enhanced clearance is much more dependent on urine pH rather than urine flow

TAS Accidents and Poisoning ✅ (12 decks)

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