Aspirin
Reye's syndrome
Aspirin
Acetylsalicylic acid.
Indications
Mild analgesia, pyrexia, inflammation. Antiplatelet: post-MI, CVA/stroke.
Mechanism
Irreversible COX inhibitor.
Evidence
Aspirin post-MI ↓ risk death/MI (AMIS N=4500).
Adverse effects
GI bleeding (enteric coating may reduce this by 3×).
Reye's syndrome (aspirin contraindicated in children <12 aet.).
Overdose
Tachypnoea←aciosis, tinnitus, deafness,
N&V, sweating. Severe: convulsions, respiratory failure, coma, death.
Protect airway, NG tube, empty stomach. Activated charcoal.
Fluid resuscitation, 1.26% HCO3 when plasma salicylate >500 mg/l (adult)
>350 mg/l (child). Acidosis or >700 mg/l &implies; haemodialysis.
Diazepam for convulsions. Also check paracetamol levels.
Reye's syndrome
Fulminant encephalopathy, hepatocellular dysfunction.
Rare. Occurs in children, 1/52 after viral infection. Associated with
Aspirin ingestion.
Ix
LFT's often normal. ↓glucose, ↓PT/INR,
↑Plasma NH3, ↑urate, ↑CK-MM.
Characteristic liver biopsy.
Treatment
Admit ITU. Mechanical ventilation. Continuous IVI 10% dextrose. Vit-K to raise PT.