Question

A young female comes to the emergency department after consuming 100 aspirin tablets.What should be the next step in management?

• A. N-acetyl cysteine to replenish glutathione stores
• B. Pralidoxime
• C. Glucagon to control bradycardia and hypoglycemia
• D. Give sodium bicarbonate to alkalize urine

Answer 1

The Correct Option is D

A young female is admitted to the emergency department after consuming 100 aspirin tablets. An acute aspirin overdose can lead to salicylate toxicity, causing metabolic acidosis, respiratory alkalosis, and potential renal complications. The key to managing aspirin overdose involves multiple steps:

1. Initial Stabilization: Ensure airway, breathing, and circulation (ABCs) are stable. Administer supportive care as necessary.
2. Decontamination: Activated charcoal may be administered if the patient presents within 1-2 hours of ingestion, provided they have a protected airway.
3. Alkalinization of Urine: Aspirin is a weak acid, and its renal elimination can be enhanced by alkalinizing the urine. This is achieved by administering intravenous sodium bicarbonate. Sodium bicarbonate increases the urinary pH, enhancing the excretion of salicylate and thus reducing its toxic effects.
4. Monitoring and Support: Continuously monitor blood gases, electrolytes, and renal function. Symptomatic treatment should be provided in conjunction with specialists if needed.
5. Consider Hemodialysis: Reserved for severe cases with symptoms like altered mental status, pulmonary edema, or renal failure. It effectively removes salicylate from the bloodstream.

Therefore, in this case, the next step in management, after stabilization of vital signs and decontamination if appropriate, is to give sodium bicarbonate to alkalize urine, facilitating the excretion of aspirin. This approach helps to mitigate the toxic effects more efficiently.