Introduction - Uppsala Monitoring Centre

Table 9. Aspirin serum concentrations and symptoms
Serum salicylate levels frequently do not reflect the severity of poisoning.
Mg/dl Grading Symptoms
2 0-30 Salicylism Aspirin: no symptoms (Hoffman et al., 1949)
Sodium Salicylate: erythema, tinnitus, deafness, nausea, vomiting
(Graham & Parker, 1948)
3 0-40 Salicylism Aspirin: tinnitus, partial deafness, nausea/vomiting, general feeling of
intoxication (Hoffman et al., 1949)
Sodium salicylate: albuminuria, hyperventilation, sweating and headache
(Graham & Parker, 1948)
40-50 Intoxication Sodium Salicylate: vertigo, drowsiness, haematuria, confusion, excitement,
and severe dyspnoea (Graham & Parker, 1948)
50-80 Mild Aspirin: hyperpnoea, marked lethargy and/ or excitability; hypocapnia
without acidosis (Rainsford, 2004)
80-100
110
Moderate
Severe
Aspirin: severe hypopnoea, marked lethargy and/ or excitability, vomiting
in children, and compensated metabolic acidosis (Rainsford,
2004) Aspirin: coma, possible convulsions, uncompensated metabolic acidosis
in children after 12 hours (Rainsford, 2004)
160 Usually lethal Aspirin (Rainsford, 2004)
Relating dosage to symptoms
The following 4 categories are helpful for assessing the potential severity and
morbidity of an acute, single event, non enteric-coated, salicylate ingestion:
1. Less than 150 mg/kg – Spectrum ranges from no toxicity to mild toxicity
2. From 150-300 mg/kg – Mild-to-moderate toxicity
3. From 301-500 mg/kg – Serious toxicity
4. Greater than 500 mg/kg – Potentially lethal toxicity
(http://www.emedicine.com/emerg/byname/toxicity-salicylate.htm)
It was said that the raison d’etre for Aspirin was that it had less gastric problems
that its predecessors, but it was in fact more toxic to the stomach, as Rainsford
points out, the Gastric lesion index in rats was 63.0 for Aspirin whilst for salicylic acid
it was 16.0 and for sodium salicylate it was 10.6. As was seen with mercury one of
the adverse effects of Aspirin has a unexpected benefit in that with some suicidal
attempts the resultant gastric irritation is so severe that the patient promptly vomits
up the stomach including a lot of the Aspirin so saving the patient’s life.