title: Absorption of salicylate powders versus tablets following overdose: a poison center observational study.
abstract: BACKGROUND
  Salicylate absorption following overdose of aspirin (ASA) tablet formulations can be prolonged for greater than 24 h. Accordingly, serial serum concentrations are typically recommended to guide treatment. However, there are little published data on absorption following ingestion of powder ASA formulations, and it is not known if delayed ASA absorption occurs following overdose of powder formulations. The objective of this study is to compare the absorption characteristics of powder and tablet formulations of ASA in patients reported to a single poison center.
  
  
  METHODS
  Electronic records from an accredited poison center were searched for single substance acute or acute on chronic ingestions of ASA in powder form between 1 January 2002 and 31 January 2014. An identical search for ingestions of ASA tablet products between 1 January 2012 and 31 December 2013 was undertaken as the comparator group. Other inclusion criteria were age >12 years, documented time of ingestion, treatment in a health care facility within nine hours of ingestion and at least two detectable serum salicylate concentrations.
  
  
  RESULTS
  16 of 25 powder and 22 of 49 tablet cases met inclusion criteria for analysis. Repeat serum salicylate concentrations following ingestion of tablets increased or insignificantly changed in 11 of 22 (50%) cases, and median serum salicylate concentrations in followed cases remained elevated for up to 12 h in some cases. In comparison, serum salicylate concentrations following powder ingestions declined in 15 of 16 (94%) cases. One patient, who ingested a powder product, underwent hemodialysis pursuant to an initial serum salicylate concentration of 96 mg/dL.
  
  
  CONCLUSIONS
  In contrast to persistent concentrations following overdose of tablets, the majority of serum salicylate concentrations declined following ingestion of powder formulations. In this small study population, these findings suggest that prolonged absorption is unlikely following ingestions of ASA powders.
authors.affiliation: a Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Poison Center , Virginia Commonwealth University , Richmond , VA , USA.
authors.forename: S Rutherfoord
authors.initials: SR
authors.lastname: Rose
authors.affiliation: a Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Poison Center , Virginia Commonwealth University , Richmond , VA , USA.
authors.forename: Kirk L
authors.initials: KL
authors.lastname: Cumpston
authors.affiliation: a Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Poison Center , Virginia Commonwealth University , Richmond , VA , USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Kim
authors.affiliation: a Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Poison Center , Virginia Commonwealth University , Richmond , VA , USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Difranco
authors.affiliation: a Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Poison Center , Virginia Commonwealth University , Richmond , VA , USA.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Wills
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D001241:Aspirin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D011208:Powders; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012459:Salicylates / Q000097:blood*; D013607:Tablets; D013997:Time Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D011208:Powders; D012459:Salicylates; D013607:Tablets; D001241:Aspirin
keywords: ASA; Absorption; dosage form; formulation; serum concentration