During his third admission, he overdosed with aspirin while on the ward recovering from the previous aspirin overdose.

Over the course of two months, a 75-year-old Caucasian man weighing 45kg who had a history of multiple previous drug overdoses, depression, bulimia and stage 3 chronic kidney disease (creatinine between 160μmol/L and 140μmol/L, that is, estimated glomerular filtration rate, 39ml/min/1.73m 2 to 46ml/min/1.73m 2) presented on three occasions to St Vincent’s Hospital following aspirin overdoses. Our aim in this report was to use the unusual and possibly one-of-a-kind opportunity to describe repeated overdose in the same individual with a focus on (1) the present treatment modalities for aspirin overdose and (2) the variability in the time course of plasma salicylate concentrations between episodes and the potential influences of therapeutic interventions. We present the case of a patient who presented with aspirin overdoses on four occasions over the course of two months at a tertiary university hospital. Salicylate, a metabolite of aspirin, seems to be responsible for the toxic effects of the drug. Despite its decreasing incidence, aspirin poisoning remains an important clinical problem involving accidental ingestion in children and intentional overdose in adults. Strategies such as child-resistant packaging and reducing the amount of medication in each package of OTC analgesics have also contributed to a decrease in the incidence of aspirin poisoning. Evidence of an association between aspirin and Reye’s syndrome has also contributed significantly to decreasing aspirin use in children. Use of this drug has decreased because of the availability of newer anti-inflammatory drugs that are better tolerated for the treatment of musculoskeletal pain and inflammation. It is, therefore, important to monitor the implementation of available guidelines.Īspirin is readily available as an over-the-counter (OTC) medication. Our experience in this case also revealed considerable unexplained variation in management despite the availability of guidelines. Repeated doses of charcoal may be a worthwhile intervention when there is no risk of aspiration. Correction of hypokalemia is recommended. In a patient with impaired renal function, intravenous fluid and urinary alkalization are the mainstays of treatment of aspirin overdose. A plasma potassium concentration of approximately 4mmol/L appeared to be needed for adequate urinary alkalization. Urinary alkalization was not attempted during the first admission, which was associated with the longest apparent elimination half-life of salicylate (30 hours). On each occasion, he was given intravenous fluid with the aim of achieving euvolemia.

A single dose of activated charcoal was administered only after the second overdose.

This categorization was more consistent with the clinical severity of his admissions. However, as assessed by the observed salicylate concentrations, the ingestions would more appropriately have been categorized as being of “moderate” severity for the first and second overdose and “mild” severity for each of the others. The overdoses were categorized as “potentially lethal” on two occasions and as “serious” in the other two, based on the alleged dose of aspirin ingested (over 500mg/kg in the first two overdoses, and 320mg/kg and 498mg/kg in the other two, respectively). During his third admission, he overdosed with aspirin, while on the ward recovering from the previous aspirin overdose. Case presentationĪ 75-year-old Caucasian man who weighed 45kg and had an extensive history of various drug overdoses and stage 3 chronic kidney disease presented to a tertiary university hospital on three occasions within 2 months after successive overdoses of aspirin. The case provided an unusual and possibly one-of-a-kind opportunity to focus on the variability in the time course of plasma salicylate concentrations with current treatment modalities of aspirin overdose in an individual patient. The patient described in this case report intentionally ingested overdoses of aspirin on repeated occasions. Aspirin overdose, though now infrequently encountered, nevertheless continues to contribute to significant morbidity and mortality.

Aspirin poisoning antidote