Suicide attempt by means of aspirin enema

OBJECTIVE: To report a suicide attempt with an aspirin enema. CASE SUMMARY: A patient presented to the emergency room after self-administering, in enema form, approximately 700 aspirin tablets dissolved in water. Over the next 12 hours the patient became progressively acidemic with eventual cardiac arrest and subsequent chronic hypoxic encephalopathy. DISCUSSION: This patient's poor outcome was the result of retained aspirin products in the rectal vault combined with the failure to recognize the delayed absorption properties of rectally administered aspirin. CONCLUSIONS: In rectal aspirin overdoses, aspirin absorption from the rectum may occur over a long period of time. It is important to remove as much aspirin from the rectum as possible and to closely monitor these patients so that appropriate therapy may be started quickly. Activated charcoal given both in enema and oral form may help decrease aspirin absorption. Hemodialysis should be available and performed without delay should the patient require it.