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Management of Aspirin and Paracetamol Poisoning

Aspirin (Salicylate) Poisoning

Aspirin poisoning occurs due to an overdose of acetylsalicylic acid, which leads to metabolic disturbances and systemic toxicity. The toxic dose varies with chronic versus acute exposure, with adults experiencing toxicity at around 150 mg/kg.

Management

1. Initial Assessment and Stabilization

  • Assess airway, breathing, and circulation (ABC).
  • Monitor vital signs, consciousness level, and oxygen saturation.
  • Establish intravenous access and consider supplemental oxygen if needed.

2. Decontamination

  • Activated Charcoal: Administered if the patient presents within 1-2 hours of ingestion. Dose: 1 g/kg in adults.
  • Gastric Lavage: Rarely indicated but may be considered in massive ingestion cases presenting within one hour.

3. Monitoring and Supportive Care

  • Blood Salicylate Levels: Measure serum salicylate concentration to determine toxicity level and monitor every 2 hours.
  • Electrolytes and Blood pH: Check blood gases and electrolytes frequently to monitor for metabolic acidosis.
  • Fluids and Electrolytes: Correct electrolyte imbalances, such as hypokalemia, and monitor hydration status.

4. Enhanced Elimination

  • Alkaline Diuresis: Sodium bicarbonate infusion helps in promoting salicylate excretion by alkalizing urine. Typically, 1-2 mEq/kg of sodium bicarbonate is added to IV fluids.
  • Hemodialysis: Considered in severe cases where salicylate levels exceed 100 mg/dL or if the patient presents with severe acidosis, renal failure, or altered mental status.

Paracetamol (Acetaminophen) Poisoning

Paracetamol poisoning can lead to acute liver failure due to the formation of a toxic metabolite, N-acetyl-p-benzoquinone imine (NAPQI), especially when hepatic glutathione stores are depleted. Toxicity generally occurs at doses above 150 mg/kg in adults.

Management

1. Initial Assessment and Stabilization

  • Assess and manage airway, breathing, and circulation (ABC).
  • Check vitals and establish IV access.

2. Decontamination

  • Activated Charcoal: Effective if administered within 1-2 hours post-ingestion. Dose: 1 g/kg for adults.

3. Acetaminophen Blood Level Measurement

Obtain blood levels 4 hours post-ingestion or as soon as possible after that to determine potential toxicity. Use the Rumack-Matthew Nomogram to assess the need for antidote therapy.

4. Antidote Therapy

  • N-Acetylcysteine (NAC): NAC replenishes glutathione and neutralizes NAPQI.
    • Oral NAC: Loading dose of 140 mg/kg, followed by 70 mg/kg every 4 hours for a total of 17 doses.
    • IV NAC: Initial dose of 150 mg/kg over 1 hour, followed by 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours.

5. Liver Function Monitoring

  • Regularly assess liver enzymes, bilirubin, and coagulation profile to monitor for signs of liver damage or failure.
  • In cases of severe liver injury, evaluate the need for liver transplantation.