Aspirin overdose
Aspirin (Acetylsalicylic acid (ASA), salicylic ester of acetic acid) is a drug that has antipyretic, analgesic, anti-inflammatory and antiplatelet effects. It belongs to the clinical and pharmacological groups of non-steroidal anti-inflammatory drugs (NSAIDs), salicylic acid derivatives and antiplatelet agents.
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Economic affordability, combined with high efficiency and favorable safety profile, allowed Aspirin to be included in the list of essential drugs of the World Health Organization. In the Russian Federation, the drug is included in the list of vital.
Acetylsalicylic acid as the main active substance is a part of many one-component preparations produced under various commercial names, the most famous of which are Aspirin-cardio, Cardiomagnyl, CardiASK, Thrombo ACC, Upsarin Oopsa. In addition to monopreparations, Aspirin, as a component, is part of the following combined agents: Alka-Seltzer, Antigrippin, Cardiomagnyl, Citramon, Excedrin, etc.
The mechanism of action of Aspirin is associated with the inhibition of cyclooxygenase, a key enzyme for the conversion of arachidonic acid, which plays one of the main roles in the development of inflammation, pain syndrome and fever. In addition, acetylsalicylic acid reduces the "sticking" of platelets and, as a result, thrombus formation, due to which Aspirin is effective in preventing diseases of the cardiovascular system (reduces not only mortality, but also the risk of developing myocardial infarction in unstable angina pectoris).
The main disadvantages of ASA is the ability to cause hemorrhagic complications (due to increased bleeding) and to provoke ulceration of the mucous membrane of the stomach and duodenum.
The main indications for the use of Aspirin:
- as part of the complex therapy of rheumatism, rheumatoid arthritis;
- infectious and allergic myocarditis;
- fever with infectious and inflammatory diseases;
- pain syndrome of weak and moderate intensity of various origins (including neuralgia, myalgia, headache);
- prevention of thrombosis and embolism;
- primary and secondary prevention of myocardial infarction;
- prevention of cerebrovascular accidents by ischemic type;
- in clinical immunology and allergology, it is used in gradually increasing doses for prolonged aspirin desensitization and the formation of persistent NSAID tolerance in patients with aspirin asthma and the aspirin triad.
Aspirin should be taken with extreme caution by pregnant and lactating women. So, its use in the first trimester can cause splitting of the upper palate of the fetus, and in the third trimester it provokes a weakening of labor, premature closure of the ductus arteriosus in the fetus, hyperplasia of the pulmonary vessels and hypertension in the pulmonary circulation.
Since Aspirin in large quantities passes into breast milk, it can provoke bleeding in a newborn.
It is prohibited for use in children under 15 years of age due to the high risk of Reye's syndrome (acute encephalopathy with cerebral edema and liver tissue damage).
How much Aspirin is needed for an overdose?
A single dose for adults and children over 15 years old varies from 40 mg to 1 g, the daily dose is from 150 mg to 8 g, the frequency of use is 2-6 times a day. The maximum duration of aspirin therapy is 10 days (in the absence of side effects); for longer use, consultation with the attending physician is necessary.
Prescription to children is possible strictly according to indications and under medical supervision: at the age of 2 to 3 years, no more than 100 mg per day, from 4 to 6 years, the maximum dose is 200 mg, from 7 and older - 300 mg per day.
The severity of overdose symptoms depends on the dose taken:
- 150-300 mg / kg - moderate overdose;
- 300-500 mg / kg - significant;
- more than 500 mg / kg is potentially fatal.
Signs of overdose
Acute overdose
The clinical picture of an acute overdose is formed within 3-8 hours from the moment of using an excessive dose of Aspirin:
- nausea, vomiting;
- speech and motor excitement, euphoria;
- dizziness, headache;
- noise, ringing in the ears, hearing and visual impairment;
- increased body temperature;
- convulsions;
- increased breathing, shortness of breath;
- change in heart rate (both brady and tachycardia are possible), heart rhythm disturbances;
- the development of bleeding of various localization (including small in the form of subcutaneous hemorrhages, gingival, nosebleeds, the appearance of traces of blood in the urine, stool, etc.);
- in severe cases, depression of consciousness develops, a coma sets in.
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Chronic overdose
Chronic overdose develops as a result of long-term systematic intake of high doses of Aspirin, more often in the elderly.
The symptoms that arise in this case are similar to the manifestations of acute intoxication:
- hearing loss, tinnitus;
- dyspeptic disorders;
- dyspnea;
- tachycardia at rest or with light exertion;
- episodes of unmotivated hyperthermia;
- stunnedness or, on the contrary, episodes of spontaneous excitement and hyperactivity, slurred speech, depression of consciousness.
Despite the uniformity of symptoms, the diagnosis of chronic overdose is often hampered by the slow development and low intensity of clinical manifestations.
Reye's syndrome
Acute overdose of Aspirin in rare cases is complicated by the development of Reye's syndrome. This condition is life-threatening and occurs most often in children under 12 years of age. The main signs that allow one to suspect its development are:
- childhood;
- indomitable vomiting, accompanied by a change in neurological status;
- sudden depression of consciousness, coma;
- oppression of the basic functions of life support (impaired respiration, cardiac activity, the development of arterial hypotension);
- thrombohemorrhagic syndrome;
- previous (4-6 days) acute viral infection, during which pharmacotherapy was carried out with Aspirin.
First aid for an overdose of Aspirin
- Stop taking the medicine immediately.
- Carry out a gastric lavage (drink 1–1.5 liters of warm water or a weak solution of potassium permanganate (potassium permanganate) and induce vomiting by pressing on the root of the tongue). Rinsing is effective if no more than 1 hour has passed since the drug was taken.
- Take enterosorbent (Polyphepan, Enterosgel, Polysorb, Lactofiltrum according to the scheme or activated carbon at the rate of 1 tablet per 10 kg of body weight).
- Take a saline laxative (magnesium sulfate).
Antidote
There is no specific antidote for Aspirin.
When is medical attention required?
Medical assistance is needed in a number of cases:
- a pregnant woman, a child, an elderly person was injured;
- after providing first aid, the victim's condition is unchanged or worsening is noted;
- indomitable vomiting;
- traces of blood in vomit, feces;
- bleeding (regardless of location);
- neurological symptoms (hallucinations, disorientation, depression of consciousness, uncontrolled psychomotor agitation, blurred speech);
- the victim is not available to contact, is in a state of oppressed consciousness;
- uncontrolled increase in body temperature;
- bradycardia less than 45-50 beats / min, sharp tachycardia or arrhythmia.
If necessary, the victim is hospitalized in the specialized department of the hospital, where he is provided with qualified medical assistance:
- alkalinization of blood with hypertonic sodium bicarbonate solution;
- forced diuresis with Furosemide (to activate the excretion of metabolites of the drug by the kidneys);
- with the development of bleeding - filling the deficit in the volume of circulating blood (Reopolyglyukin, Gemodez), oxygen and hemostatic therapy (Etamsilat, Ditsinon), if necessary - surgical intervention;
- hepatoprotectors (Essentiale, Heptral, Karsil);
- extracorporeal detoxification methods;
- oxygen therapy, mechanical ventilation;
- with the development of convulsive syndrome - benzodiazepines.
Possible consequences
The consequences of an overdose with Aspirin can be:
- acute hepatic and / or renal failure;
- toxic hepatitis;
- acute lung injury;
- metabolic ketoacidosis;
- the appearance of ulcerative defects on the mucous membrane of the stomach and duodenum;
- bleeding of various localization;
- coma, death.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
