Aspirin Overdose

Aspirin is one of the most commonly used drugs in history. Aspirin is used for many different reasons. People use Aspirin for its cardiovascular blood thinning properties, for its pain relieving properties and for it antipyretic properties, to name a few. Most people don't know what Aspirin is, but only what it does for their particular needs. I will attempt to describe some different aspects of Aspirin and Aspirin overdose. I will give a brief description of what Aspirin is, chemically speaking and where aspirin originates from. The use of Aspirin for attempted suicide is common as a primary drug or as a co-drug. I will explain the possible signs and symptoms an overdose patient will experience, and the assessment, and the prehospital treatment for the patient.

Aspirin is derived from a chemical extracted from willow bark: Salicylate Acid. Salicylate Acid has a long history of uses. During Medieval times herbalists used it for its palliative properties. In the mid 1900's, chemists isolated the active ingredient of willow bark, salicylic acid, and Aspirin was developed. It quickly became the drug of choice as a pain reliever, antipyretic and anti-inflammatory. The first company to develop Aspirin for commercial use was the Bayer Company. Today Aspirin is used daily by millions of Americans to help reduce the risk a heart attack. Until the late 1900's, with the development of Aspirin alternatives such as acetaminophen and ibuprofen, Aspirin was the most widely used drug around, and a common drug of choice for the overdose patient.

Aspirin has many affects on the body when taken in excess amounts. One common affect is hyperventilation, which causes the patients PCO2 to drop from normal limits. The body will attempt to compensate for this by excreting bicarbonate, which results in an increase in pH blood levels. If this is not corrected, it will lead to metabolic alkalosis. Excess amounts of Aspirin will have many affects varying in severity such as severe illness, seizures, shock, and sometimes coma. Some of the more common symptoms include hypotension, tachycardia, tachypnea, nausea and vomiting, decreased level of consciousness, hypoglycemia, and tinnitus.

During the pre-hospital initial assessment of the patient with a possible Aspirin overdose, it is essential to stabilize all life threatening conditions. The patient needs to be placed in the ambulance for continuous vital sign monitoring including electrocardiogram (ECG). After all life threats have been addressed, the paramedic should focus on the history of the overdose. If the patient presents with suicidal tendencies, he/she needs to be evaluated by a Psychiatrist. The patient who presents with an attempted suicidal overdose should be questioned about other drugs taken. Aspirin is commonly taken as a co-drug during a suicidal attempt. If the patient took a narcotic and has a decreased level of consciousness the administration of Naloxone should be considered. Information should be gathered about underlying medical conditions that could complicate an Aspirin overdose, such as CHF or bleeding disorders. The patient should have his or her blood glucose measured because hypoglycemia is often overlooked in an overdose patient.

Treatment for the patient of an Aspirin overdose depends on the assessment findings. To paraphrase Paracelsus (1998): "The only thing which differentiates a poison from a remedy is the dose." (p. 675)

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