A Frightening Arrival at the Emergency Room
Emergency physicians in Michigan encountered a case that first appeared to be a psychiatric emergency. A 65-year-old woman arrived at the emergency department by ambulance and asked to see a psychiatrist because of visual hallucinations. "I'm seeing dead people," she told clinicians, according to a published report of her case. She added that on one occasion she had fired a gun at the hallucinations.
Despite the alarming nature of that disclosure, the woman was calm and alert during her physical exam. Her vital signs were normal, with the exception of high blood pressure. She reported a history of high blood pressure, diabetes, heart failure and chronic back pain, but she had no prior psychiatric history.
That last detail shaped the direction of her care. Rather than treating the episode as a primary mental health crisis, the team decided to pursue a medical assessment before involving a psychiatrist.
A Medical Workup Before a Psychiatric Consultation
When visual hallucinations appear suddenly in an older adult who has never had a psychiatric diagnosis, clinicians often consider physical causes as well. Medications, metabolic problems and toxic exposures can all produce hallucinations that mimic psychiatric illness. In this case, the patient's age and her complex medical history gave doctors several reasons to look beyond the surface presentation.
Laboratory testing became the next step, and the results pointed away from a primary psychiatric explanation.
Blood Tests Revealed Acidosis and High Salicylate Levels
A blood test showed that the woman had mild metabolic acidosis, meaning her blood was too acidic. A toxicology screen detected high levels of salicylates — a class of compounds that includes acetylsalicylic acid, better known as aspirin.
Those findings led clinicians to ask more detailed questions about what the woman had been taking. She acknowledged that she had been consuming more than 15 aspirin pills per day for multiple weeks. Each of the pills, marketed for back and body pain, contained 500 milligrams of aspirin.
She also confirmed that she had tinnitus, a ringing in her ears that is a classic symptom of salicylate toxicity. Taken together, the medication history, the blood work and the tinnitus produced a clear conclusion: the woman had overdosed on aspirin, a condition known as salicylate toxicity.
The Over-the-Counter Medicine at the Center of the Case
Aspirin is among the most widely used medications in the world. It is available without a prescription and is taken for pain, fever and inflammation. Because it is sold over the counter, it can be easy to regard as harmless, yet it remains a pharmacologically active drug with a defined dose range.
The pills in this case were formulated for back and body pain and contained 500 milligrams of aspirin each. By taking more than 15 of them daily over a period of weeks, the woman exposed her body to a sustained, high dose of the drug. In her case, clinicians concluded that this sustained exposure had produced salicylate toxicity, with metabolic acidosis detected on blood testing and visual hallucinations as the presenting complaint.
How the Overdose Was Treated
Once the diagnosis was established, the woman's doctors consulted experts at Michigan's poison control center. The specialists recommended intravenous treatment with sodium bicarbonate — the chemical name for baking soda. This treatment alkalinizes the blood and urine, countering the acidic state revealed by the blood test.
Sodium bicarbonate is a common household item, but in a hospital setting it is delivered intravenously and dosed under medical supervision. Poison control centers are staffed by specialists trained in managing toxic exposures, and their guidance is often sought when a medication overdose is identified.
What the Case Report Does and Does Not Say
The published account focuses on the diagnostic path rather than the aftermath. It does not describe how long the woman stayed in the hospital, how quickly her hallucinations resolved, or what her final outcome was. Nor does it detail what the hallucinations looked like, only that she reported seeing dead people and reacted by firing a gun.
What the report does provide is a step-by-step sequence. A 65-year-old woman with no psychiatric history presented with visual hallucinations. Her exam was otherwise unremarkable apart from high blood pressure. Blood work showed metabolic acidosis and elevated salicylates. Questioning revealed weeks of high-dose aspirin use and the presence of tinnitus. Poison control then recommended intravenous sodium bicarbonate to alkalinize her blood and urine.
Key Facts From the Case
- Patient: a 65-year-old woman in Michigan.
- Symptoms: visual hallucinations, including seeing dead people; she fired a gun at the hallucinations once.
- Medical history: high blood pressure, diabetes, heart failure and chronic back pain, with no prior psychiatric history.
- Exam: calm and alert, with normal vital signs other than high blood pressure.
- Labs: mild metabolic acidosis and high salicylate levels.
- Medication history: more than 15 aspirin pills per day for multiple weeks; each pill contained 500 milligrams of aspirin.
- Additional sign: tinnitus, a classic symptom of salicylate toxicity.
- Diagnosis: salicylate toxicity, or aspirin overdose.
- Treatment: poison control recommended intravenous sodium bicarbonate, which alkalinizes blood and urine.
Why the Case Matters
The case illustrates why a sudden change in perception or mental status deserves a broad medical evaluation, especially in older adults with chronic health conditions. Visual hallucinations can be the first sign of a physical problem rather than a primary psychiatric disorder, and the absence of any psychiatric history can be a meaningful clue for clinicians deciding where to look first.
It also serves as a reminder that over-the-counter status does not mean a drug is risk-free. Aspirin is a salicylate, and salicylate toxicity is a recognized consequence of excessive dosing. The woman in this case was taking a pain formulation at a dose and duration that produced measurable toxicity, including acidosis and ringing in the ears.
For clinicians, the case underscores the value of listening to the full story. The woman's own report of tinnitus was a classic marker of salicylate toxicity, and her acknowledgment of heavy aspirin use completed the diagnostic picture. Together with the laboratory findings, those details turned what looked like a psychiatric crisis into a treatable medical diagnosis.
This article is based on reporting by Live Science. Read the original article.
Originally published on livescience.com
