Acute Aspirin Single Substance Poisoning in Pediatric Patients

Objective: Little data has been published regarding aspirin intoxication in pediatric patients. The most recent expert consensus review of salicylate exposures recommended referral to the emergency department when patients with an acute unintentional exposure have ingested at least 150 mg/kg or 6.5 g of aspirin, whichever is less. There has been no validation of this consensus guideline. Therefore, this study aims to determine the incidence, clinical effects, and management of single substance aspirin exposures in pediatric patients. Methods: An institutional review board approved retrospective review of data from the National Poison Data System on pediatric patients with single substance aspirin exposures between January 2000 and December 2018 was conducted. Patients ages 5 years and younger were included if they were followed to a known outcome. The primary endpoint was to associate doses of aspirin with levels of toxicity. Secondary outcomes included the incidence of acute aspirin single substance exposure, symptoms and treatments for toxicity, and mortality related to aspirin ingestion. Results: Aspirin exposures in children 0-5 years old stayed relatively stable over the study period with 68,879 aspirin exposures observed. Most of the included exposures resulted in no effect (n=24,266; 92.4%) followed by minor effect (n=1,549; 5.9%), moderate effect (n=392; 1.5%), major effect (n=42; 0.2%), and death (n=6; 0.02%). The median dose for moderate effects, major effects, and death was 148, 173, and 284 mg/kg, respectively. The majority of non-severe symptoms reported were gastrointestinal and the most common severe symptoms were tachycardia, tachypnea, and acidosis. The most common treatments were administration of intravenous fluids, single dose activated charcoal, and alkalinization. Conclusion: Severe effects predominate at doses greater than 150 mg/kg in children 0-5 years old with unintentional exposures, supporting the current cutoff of 150 mg/kg per the latest consensus review. Conclusions: Inhibition of PCDH-PC expression reduced the invasiveness of androgen-independent prostate cancer cells.