Poisoning with
salicylic acid and its derivatives is a quite common event, leading to possibly life-threatening complications. A case of fatal intoxication of a sixty-year old patient with
acetylsalicylic acid is described and the therapeutic options are discussed. In acute
poisoning it is mandatory to initiate simple and effective measures first. This gives time for discussing and planning the more laborious procedures. The initial treatment of
salicylate poisoning is based on the prevention of further absorption by a sufficiently large quantity of orally administered
activated charcoal (approximately 1 g/kg b.w.). Given repeatedly,
activated charcoal may enhance non-renal clearance of
salicylates. Intravenously administered
sodium bicarbonate counteracts the
metabolic acidosis. Moreover,
bicarbonate therapy limits tissue distribution of the
drug and enhances its renal excretion. The availability of
glycine for
salicylic acid metabolism may be limited in
poisoning because
glycine has been used for forming the conjugation product
salicyluric acid.
Glycine may be administered orally to overcome this bottleneck. Gastric lavage has been proven to be of limited efficacy. This efficacy is further diminished if gastric lavage is performed late after
drug ingestion. When it is performed, however,
activated charcoal should be administered before and after gastric lavage. Whenever the more simple treatment options fail,
hemodialysis or
hemoperfusion should be additionally considered since these procedures are effective in removing
salicylates from the body.