Management of Aspirin Overdose

Primary Treatments for Salicylate Poisoning

The cornerstones of therapy for salicylate poisoning include supportive care, gastrointestinal decontamination in selected patients, repletion of intravascular volume, and bicarbonate administration 1
Sodium bicarbonate is the mainstay treatment for salicylate toxicity, as it produces alkalemia and alkaluria, which minimizes passage of salicylate into the central nervous system and promotes renal excretion of salicylate 1
Urinary pH values should be targeted to reach 7.5 to 8.0 to maximize salicylate excretion 1

Hemodialysis is recommended for severe salicylate poisoning, including cases with altered mental status, acute respiratory distress syndrome, failure to respond to standard therapy, or clinical deterioration despite good supportive care 1
Specific salicylate concentration thresholds that may warrant extracorporeal treatment include acute poisoning: 5.8-9.4 mmol/L and chronic poisoning: 3.6-4.2 mmol/L 1
Clinical status is more important than absolute salicylate concentration when deciding to initiate extracorporeal treatment 1

Assess severity of poisoning, including mental status, respiratory function, and acid-base status, then initiate supportive care and gastrointestinal decontamination if appropriate, followed by intravenous fluids for intravascular volume repletion, and sodium bicarbonate therapy to achieve alkalemia and alkaluria 1
Consider hemodialysis for severe poisoning or clinical deterioration, and consult with a clinical toxicologist or poison center for complex cases 1