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Activated Charcoal and Bicarbonate for Aspirin Toxicity: a Retrospective Series

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Abstract

Introduction

Aspirin overdose causes acid–base disturbances and organ dysfunction. Management is guided by research reported over 50 years ago when chronic aspirin toxicity was common and accounted for significant morbidity. We investigate our experience of aspirin overdose and the effectiveness of charcoal and bicarbonate administration over 20 years.

Methods

This is a retrospective series of acute aspirin overdose from two toxicology units from January 2000 to September 2019. Acute aspirin ingestions > 3000 mg were identified in each unit’s database. Excluded were cases of chronic exposure, hospital presentation > 24 hours after ingestion, and cases without a salicylate concentration. Included in our analysis was demographic data, clinical effects, investigations, complications, and treatment.

Results

There were 132 presentations in 108 patients (79 females (73%)). The median age was 28 years (range: 13–93 years). The median dose ingested was 7750 mg (IQR: 6000–14,400 mg). There were 44 aspirin-only ingestions. Mild toxicity (nausea, vomiting, tinnitus or hyperventilation) occurred in 22 with a median dose of 160 mg/kg. Moderate toxicity (acid–base disturbance, confusion) occurred in 16 with a median ingested dose of 297 mg/kg. There were no cases of severe toxicity (coma or seizures) due to aspirin alone. The median peak salicylate concentration was 276 mg/L (IQR: 175–400 mg/L, range: 14–814 mg/L). There was a moderate association between dose ingested and peak concentration (Pearson r = 0.58; 95% CI 0.45–0.68). Activated charcoal was administered in 36 (27%) cases, which decreased the median peak salicylate concentration (34.2 to 24.8 mg/L/g (difference: 9.4, 95% CI: 1.0–13.1)). Bicarbonate was administered in 34 (26%) presentations, decreasing the median apparent elimination half-life from 13.4 to 9.3 h (difference: 4.2 h, 95% CI: 1.0–6.5 h).

Conclusions

Acute aspirin overdose caused only mild to moderate effects in this series. Early administration of activated charcoal decreased absorption and use of bicarbonate enhanced elimination.

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Funding

Geoff Isbister is supported by a NHMRC Senior Research Fellowship ID1061041.

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Authors and Affiliations

  1. Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia

    K. Z. Isoardi & K. Harris

  2. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia

    K. Z. Isoardi, C. Henry & K. Harris

  3. Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia

    K. Z. Isoardi & G. K. Isbister

  4. Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, NSW, Australia

    G. K. Isbister

Authors
  1. K. Z. Isoardi
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  2. C. Henry
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  3. K. Harris
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  4. G. K. Isbister
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Contributions

K.I. and G.I. conceived the study. K.I., C.H. and K.H. completed the data collection. K.I. and G.I. analyzed the data. K.I. drafted the manuscript, and all authors contributed substantially to its revision. K.I. takes responsibility for the paper as a whole.

Corresponding author

Correspondence to K. Z. Isoardi.

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The authors declare no competing interests.

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Supervising Editor: Gillian A. Beauchamp, MD.

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Meeting

Data from this study were presented at the virtual NACCT conference in October 2020 and also at the Toxicology and Poisoning Network Australasia (TAPNA) Annual Scientific Meeting in Newcastle, Australia, May 7, 2021.

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Isoardi, K.Z., Henry, C., Harris, K. et al. Activated Charcoal and Bicarbonate for Aspirin Toxicity: a Retrospective Series. J. Med. Toxicol. 18, 30–37 (2022). https://doi.org/10.1007/s13181-021-00865-0

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  • DOI: https://doi.org/10.1007/s13181-021-00865-0

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