What is an appropriate treatment for aspirin poisoning?

• A. Activated charcoal only
• B. Gastric lavage
• C. Activated charcoal, and then IV sodium bicarbonate
• D. IV fluids only

Answer: (C)

In aspirin poisoning, the goal is to prevent further absorption and quickly remove the toxin from the body. Activated charcoal binds salicylates in the gut, reducing ongoing absorption, and is most effective when given soon after ingestion. If there’s a concern for significant poisoning, following decontamination with IV sodium bicarbonate alkalinizes the urine, which increases salicylate ionization in the renal tubules. The ionized form is not reabsorbed, so it’s excreted more readily, helping to clear the toxin and address metabolic disturbances caused by salicylate overload.

Activated charcoal alone may not be enough if poisoning is moderate to severe, and IV fluids alone won’t promote elimination or correct the acid-base imbalance. Gastric lavage is invasive and not routinely indicated unless the ingestion was very recent and the patient is unstable. In extreme cases, dialysis may be needed, but the combination of decontamination with charcoal and urinary-alkalinizing therapy is the standard initial approach.