Double Trouble

In this case, a middle-aged female presents to the emergency department in a state of agitation and distress, having taken the contents of a bottle of aspirin with the intent to end her life. Her salicylate level confirms that she has taken a significant overdose, and she shows signs of toxicity. Treatment is initiated for a salicylate toxidrome. Later, in talking to the patient’s partner, the emergency physician realizes the situation is more complex than initially imagined. Although she initially shows some signs of improvement, subsequently she critically deteriorates and requires intubation. The patient is eventually transferred to the intensive care unit. The case powerfully illustrates the consequences of the cognitive biases anchoring, search satisficing, and confirmation bias.

Acetaminophen and Acetylsalicylic Acid Exposure in a Preterm Infant after Maternal Overdose

Here, we review the case of a 26 1/7 weeks' gestation premature female infant born to a mother who intentionally ingested a large quantity of Tylenol, aspirin, quetiapine, and prenatal vitamins. The neonate subsequently had markedly elevated levels of both Tylenol and aspirin when checked on the first day of life. While overall clinically stable, the neonate did demonstrate coagulopathy as evidenced by abnormal coagulation studies. Both poison control and a pediatric gastroenterologist/hepatologist were consulted. She successfully tolerated a course of N-acetylcysteine; her subsequent Tylenol level was markedly decreased and the neonate exhibited no further effects of toxicity. The salicylate level decreased on its own accord. To our knowledge, this is the first report of a neonate at 26 weeks' gestation that has been successfully managed for supratherapeutic concentrations of acetaminophen and acetylsalicylic acid secondary to maternal ingestion. While rare, this case may serve as a reference for the effectiveness of N-acetylcysteine in premature infants in such instances.

Effect of Brand on the Serum Level of Aspirin

The authors present a case of a four-year-old female, treated with aspirin for juvenile rheumatoid arthritis. A generic preparation was given first, but plasma salicylate levels remained significantly below the required therapeutic range. Upon changing to a brand-name product, however, therapeutic levels were achieved after one day. The authors conclude that the source of aspirin used had a marked effect on the serum salicylate level.