Aspirin Toxicity

00:01 So let’s go through some of the common overdoses and poisonings in children and how we manage them and what we worry about.

00:10 Let’s start with aspirin.

00:12 Aspirin toxicity is a very unique pathologic toxicity with very unique presentation.

00:21 Aspirin can cause fever.

00:23 This is through uncoupling oxidative phosphorylation.

00:27 This can also result in a metabolic acidosis.

00:31 Additionally, aspirin has a central effect on the brain which causes a primary tachypnea and a respiratory alkalosis.

00:39 So they can get both first a respiratory alkalosis a and then a metabolic acidosis as a result of their aspirin toxicity.

00:48 These patients may have an increased heart rate as well.

00:51 They may be agitated or, in severe cases, they may be in a coma.

00:56 They often appear pale or diaphoretic and they may be frankly acidotic or hypoglycemic.

01:02 The classical symptoms also include nausea and vomiting due to the resultant gastritis and tinnitus.

01:09 Furthermore, the use of aspirin is contraindicated in children, due to their risk of developing Reye syndrome, which is characterized by fatty degerative liver failure and encephalopathy.

01:21 So children can have a variety of presentations along the spectrum.

01:26 Aspirin is sometimes in other preparations and you should be aware of that especially in young children who’ve overdosed on something.

01:35 So you can find aspirin in Pepto-Bismol, which looks pink and delicious to the young children.

01:40 You may find it in wart remover medication and you may find it in some herbal remedies.

01:46 So remember if you see a child who got into the wart remover and they have a fever, that this is probably, ironically, aspirin overdose.

01:54 So how do we manage aspirin toxicity? Well, there has to be some care with the airway portion of the ABCs.

02:02 Remember, they may have a respiratory alkalosis and a metabolic acidosis.

02:08 And so close monitoring of their acid-base status is critical in a patient who’s been intubated with aspirin toxicity.

02:16 Likewise, you may want to correct any hypokalemia or hypoglycemia.

02:21 And what’s key often in all overdoses or at least many is GI decontamination.

02:27 If you can get to that patient within an hour of when they overdosed, you can administer charcoal and reduce the amount of drug that’s absorbed.

02:36 Also, we may alkalinize the urine in patients with aspirin toxicity because that may be a more efficient way of clearing the aspirin through the kidney.