Haemodialysis in acute acetylsalicylic acid poisoning

Abstract

CETYLSALICYLIC acid (aspirin) is relatively A non-poisonous but nevertheless it is not infrequently employed as a suicidal agent. In the United States, for example, salicylic acid compounds are responsible for approximately 4 per cent of all fatal cases of poisoning caused by ingestion of solids and liquids [9]. After absorption, acetylsalicylic acid hydrol zes rapidly in B the organism, and thus presents t e same clinical picture as salicylic acid poisoning. In adults, death has been caused by 10 to 30 gm. sodium salicylate or acetylsalicylic acid, but much larger quantities have been consumed (in one case 130 gm. aspirin) without death [s]. In recent years, haemodialysis by means of the “artificial kidney” has been tried as a treatment in cases of severe poisoning. Doolan et al. [d] in 1951 dialysed an adult male who had a blood concentration of 55 mg. salicylic acid per 100 ml. It was estimated that 1.3 gm. salicylic acid was removed by the dialysis, which had to be interrupted after one hour for technical reasons, but the patient died some hours later as a result of the poisoning. Schreiner et al. [9] in 1955 submitted the first known instance of the successful use of haemodialysis in a case of salicylate poisoning. The patient was a forty year old man who had consumed approximately 210 gm. aspirin. He was comatose on admission to hospital. The blood concentration of salicylate was 91 mg. per 100 ml. It was possible to remove 9.4 gm. salicylate by haemodialysis, during which the blood concentration fell to 34 mg. per 100 ml. The patient was completely well on the day following the dialysis. Later, another haemodialysis was carried out on a woman who had consumed 166 gm. aspirin. In this case the blood concentration of salicylate fell from 115 to 29 mg. per 100 ml. The patient was revived but died five days later from a violent gastrointestinal hemorrhage. Leonards [S] in 1955 dialysed two patients with salicylate poisoning, with excellent results. Details are given for one patient only: he had taken a large dose of methyl salicylate, and on admission to the hospital had a blood concentration of 130 mg. per 100 ml. salicylate. It was possible to remove 9.5 mg. salicylate by haemodialysis, the salicylate concentration falling to 30 to 40 mg. per 100 ml. The patient recovered from coma, and the respiration rate fell very quickly.