Case report of aspirin overdose: bezoar formation and controversies of multiple-dose activated charcoal in salicylate poisoning

Bezoar formation is cited to be the cause of delayed absorption of aspirin in overdose of enteric-coated aspirin preparation. However, such phenomenon from oral overdose of regular aspirin preparation has not been clearly demonstrated in human. The use of multiple-dose activated charcoal (MDAC) in salicylate poisoning remains controversial. We report a case of regular-preparation salicylate poisoning with rebound of the serum salicylate level after discontinuation of MDAC administration. Bezoar formation as the underlying cause of the rebound and the effect of MDAC on serum salicylate level are discussed. (Hong Kong j.emerg.med. 2010;17:276-280)