Aspirin (Salicylate) toxicity

How is the presentation in Children different than adults?

Can present with PURE metabolic ACIDOSIS - salicylate toxicity quickly leads to sedation and lethargy blunting their respiratory drive

Signs of SEVERE Aspirin toxicity? First step in Treatment?

Fever AMS (Confusion which progresses to lethargy and maybe even coma) seizures Noncardiogenic pulmonary edema GI bleed Liver failure Renal failure Hemodialysis

What will ABG show?

High Anion gap metabolic acidosis and respiratory alkalosis

What are signs of mild to moderate Aspirin toxicity?

Nausea, vomiting, diarrhea vertigo, Headache, Tinnitus Tachycardia, Tachypnea

What is Aspiring metabolized to?

Salicylic Acid Acts directly on respiratory center in the medulla to increase respiratory drive --> Respiratory alkalosis

How to treat Aspirin toxicity (Mild to moderate)

Supportive care (ABC's of airway and circulatory support) If recent ingestion: Activated charcoal &/or Gastric Lavage Dextrose to avoid CSF hypoglycemia IVF to replace losses Bicarb - Urine alkalinization increases rate of renal clearance - Increasing systemic pH decreases tissue distribution of salicylate

Why are overdoses so harmful?

They interfere with KREBS cycle and cause UNCOUPLING of oxidative phosphorylation --> accumulation lactate and ketoacids (anion gap)

ASA mechanism of action

irreversibly inhibits COX effective for the life of the platelet (~7days)