The dialysate can be buffered to a pH between 7.45 and 7.5 to maintain alkalemia.Consider strongly if serum salicylate concentration is > 100 mg/dL (acute ingestion) or > 60 mg/dL (acute-on-chronic or chronic ingestion), or if serum salicylate level is rising dangerously fast.Inability to adequately correct acid-base or electrolyte abnormalities.Pulmonary edema or heart failure complicating IV bicarbonate therapy.Seizures (preferably, 30 minutes before seizures occur).Worsening confusion, somnolence, or agitation suggesting CNS toxicity.Indications for dialysis (partial listing)
Hemodialysis can remove aspirin from the bloodstream and correct fluid, electrolyte, and pH balance.Hypokalemia will inhibit the ability to alkalinize urine potassium supplementation is typically necessary. Monitor urine pH carefully and try to achieve urine pH 7-8. In addition to alkalinizing the bloodstream, sodium bicarbonate helps to alkalinize the urine and promote aspirin elimination by the kidney.If mechanical ventilation becomes necessary, it is important that hyperventilation and cerebral perfusion be expertly maintained. Paralysis and endotracheal intubation may be a lethal procedure! A rise in P aCO2 (and a resultant decline in serum pH) from paralysis or hypoventilation may lead to an increase in aspirin entry to the brain, and positive-pressure ventilation may reduce cardiac filling.Beware! Giving sedatives may lead to hypoventilation and worsen aspirin poisoning. Aspirin poisoning causes hyperventilation which helps to maintain alkalemia.Administer IV sodium bicarbonate to achieve a blood pH between 7.45-7.5. Aspirin crosses the blood-brain barrier in acidic blood.Aspirin may lead to hypoglycemia and/or low CNS glucose availability: monitor blood glucose concentrations and administer dextrose as warranted.Aspirin poisoning often leads to dehydration: administer intravenous fluids as necessary to restore and maintain intravascular volume.Monitor serial serum drug levels, and carefully consider the potential benefit of activated charcoal administration or whole bowel irrigation. After overdose, aspirin may be absorbed from the gut into the bloodstream over a prolonged period of time.Principles of medical management of aspirin poisoning Aspirin poisoning is best cared for by clinicians with appropriate knowledge and experience in treating critical drug poisoning. The following information is also available as a downloadable PDF.Īspirin can be deadly in overdose! Healthcare providers are encouraged to attend to aspirin poisoning cases with the same diligence afforded to cases of sepsis or other life-threatening diseases.
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