Salicylate (aspirin) toxicity

What it is

Acute salicylate poisoning is what follows taking too much aspirin. Severity is assessed from the amount ingested and from the clinical features. Assessment starts at a dose above 150 mg/kg of aspirin equivalent, or an unknown dose, and it is that same dose that calls for oral activated charcoal. The dose above 300 mg/kg is not what calls for charcoal; it stands with the signs of severe toxicity. Aspirin and the other salicylates, including acetylsalicylic acid, are well adsorbed by activated charcoal.

Assessment of acute salicylate intoxication is based on the dose ingested, in mg/kg: below 150, no toxic reaction expected; 150-300, a mild to moderate toxic reaction; 300-500, a serious toxic reaction; and above 500, potentially lethal. The estimated severity is read from the dose in mg/kg and not from the number of pills, so the same number of pills gives a different estimated severity in a small patient and a large one, and the dose per kg has to be worked out before the severity is named.