May occur after a single dose of a large dose or with prolonged use of the drug. If a single dose of acetylsalicylic acid is less than 150 mg / kg, acute poisoning is considered easy, 150-300 mg / kg is of moderate severity, and when used at higher doses, it is severe.
Symptoms of an overdose from mild to moderate severity: dizziness, tinnitus, hearing impairment, visual impairment, increased sweating, nausea, vomiting, headache, confusion, tachypnea, hyperventilation, respiratory alkalosis.
Treatment: provocation of vomiting, repeated intake of activated carbon, forced alkaline diuresis, restoration of water-electrolyte balance and acid-base state.
Symptoms of an overdose from medium to severe:
- respiratory alkalosis with compensatory metabolic acidosis;
- hyperpyrexia (extremely high body temperature);
- breathing disorders: hyperventilation, non-cardiogenic pulmonary edema, respiratory depression, asphyxia;
- disorders of the cardiovascular system: heart rhythm disturbances, lowering of blood pressure, suppression of cardiac activity, collapse;
- disturbance of water-electrolyte balance: dehydration, disturbance of kidney function from oliguria up to the development of renal failure, characterized by hypokalemia, hypernatremia, hyponatremia;
- impaired glucose metabolism: hyperglycemia, hypoglycemia (especially in children), ketoacidosis;
- noise in the ears, deafness;
- gastrointestinal bleeding;
- hematological disorders: from inhibition of platelet aggregation to coagulopathy, prolongation of prothrombin time, hypoprothrombinemia;
- neurological disorders: toxic encephalopathy and depression of the central nervous system (drowsiness, confusion, coma, convulsions).
Treatment: Immediate hospitalization in specialized departments for emergency therapy - gastric lavage, repeated intake of activated charcoal and laxatives, alkalinization of urine (shown at a salicylate level above 500 mg / l, provided by intravenous infusion of sodium hydrogen carbonate - 88 meq per 1 liter of 5% glucose solution, at a rate of 10-15 ml / kg / h), recovery of circulating blood volume and induction of diuresis (achieved by the introduction of sodium bicarbonate in the same dose and dilution, repeated 2-3 times); it should be borne in mind that intensive infusion of fluid to elderly patients can lead to pulmonary edema. It is not recommended to use acetosolamide for urine alkalinization (can cause acidemia and enhance the toxic effect of salicylates). When carrying out alkaline diuresis, it is necessary to achieve pH values between 7.5 and 8. Hemodialysis is indicated with a salicylate level in the blood plasma of more than 1000 mg / l, and in patients with chronic poisoning - 500 mg / l and lower if there are indications (refractory acidosis, deterioration of the condition, severe central nervous system damage, pulmonary edema and renal failure).It is shown in pulmonary edema artificial ventilation with a mixture enriched in oxygen at a positive pressure mode at the end of the exhalation; To treat edema of the brain, hyperventilation and osmotic diuresis are used. The greatest risk of developing chronic intoxication is observed in the elderly with more than 100 mg / kg / day for several days. In children and elderly patients, the initial signs of salicylism (nausea, vomiting, tinnitus, visual impairment, dizziness, headache, general malaise) are not always noticeable, so it is advisable to periodically determine the salicylate content in the blood plasma.