Normal aging reduces the size of and blood flow to the liver, reducing the rate at which aspirin is hydrolyzed to salicylic acid. Further, the metabolic system is saturated with a single 325-mg aspirin tablet. The resulting loss of renal nephrons then reduces the excretion of both unchanged drug and salicylic acid. Recommend misoprostol in patients with histories of gastrointestinal problems. Confusion, delirium, agitation, hyperactivity, and restlessness with movement disorders Tinnitus progressing to hearing loss Arrhythmias from hypokalemia and dehydration Definitive diagnosis relies on serum salicylate concentrations.
Treatment includes drug withdrawal combined with supportive therapy.
If enteric-coated aspirin or gastric outlet obstruction is involved, gastric lavage, induced emesis, or activated charcoal may be indicated. Intravenous therapy is used primarily to restore hydration or acid-base balance. Hyperthermia requires tepid water sponges or cooling blankets. Home care patients with multiple medical problems are at increased risk of salicylate toxicity. Pharmacists and nurses should be aware of this potential problem, ensure that complete medication histories have been obtained, and counsel elderly patients about the high risk of developing chronic salicylate toxicity.