A woman arrived at the ER reporting terrifying hallucinations

A 65-year-old woman from Michigan was brought to the emergency room by ambulance after experiencing visual hallucinations. She asked to see a psychiatrist and told a clinician, “I see dead people.” She also reported firing guns at the hallucinations, according to her incident report. The report did not describe what the hallucinations looked like.

Despite this alarming behavior, the woman was calm and alert during her medical examination. Her vital signs were normal except for high blood pressure. She reported a history of hypertension, diabetes, heart failure and chronic back pain, but no previous psychiatric history.

Blood tests pointed to aspirin poisoning

Because the woman had no history of psychiatric illness, doctors performed a medical evaluation before consulting a psychiatrist. Blood tests showed mild metabolic acidosis, a condition in which the blood becomes too acidic.

Toxicology tests also detected high levels of salicylates, a group of compounds that includes acetylsalicylic acid, the chemical name for aspirin.

When doctors questioned her further, the woman said she had been taking more than 15 aspirin pills every day for several weeks to treat back and body pain. Each pill contained 500 milligrams of aspirin.

She also reported tinnitus, or ringing in the ears, which is a common symptom of salicylate poisoning. The findings indicated that she had overdosed on aspirin over time.

How doctors treated the aspirin overdose

Doctors consulted specialists at the Michigan Poison Control Center. The specialists recommended intravenous sodium bicarbonate, the chemical compound found in baking soda.

The treatment makes the blood and urine more alkaline, which helps the kidneys remove salicylic acid from the body through urine.

After 11 hours of intravenous treatment, the woman’s blood salicylate level fell from 28.8 milligrams per deciliter (mg/dL) to 18.3 mg/dL. Within 48 hours of arriving at the hospital, her hallucinations had stopped and her tinnitus had improved. She was discharged without needing a psychiatric evaluation.

Why can too much aspirin cause hallucinations?

Aspirin is generally safe when taken at the dose listed on the label or as directed by a doctor. However, taking too much can irritate the gastrointestinal tract and interfere with parts of the nervous system.

At high doses, salicylates can stimulate the medulla oblongata, a part of the brain that helps regulate breathing. This can cause hyperventilation, leading the body to lose too much carbon dioxide and initially making the blood more alkaline. This process is called respiratory alkalosis.

Salicylates can also disrupt metabolism, causing metabolic acidosis as lactic acid accumulates in the body. If metabolic acidosis becomes severe enough to overwhelm respiratory alkalosis, the blood can become acidic and organ failure may occur.

These metabolic effects may also contribute to tinnitus. Research suggests that increased arachidonic acid can stimulate receptors in the inner ear.

The woman’s daily aspirin intake was approximately 75 milligrams per kilogram of body weight—about half the dose typically associated with acute salicylic acid poisoning. However, taking that amount every day for several weeks, particularly in an older adult, can still create a serious risk of toxicity.

Chronic aspirin poisoning can look different from acute poisoning

The case report authors noted that the woman had tinnitus but did not experience many other typical symptoms of salicylate overdose, such as nausea or fever.

For clinicians, the case served as a reminder that long-term aspirin toxicity can produce symptoms that differ from those associated with a single, acute overdose. Previous case reports have described similar visual symptoms in patients with chronic salicylate poisoning, although the underlying causes of these symptoms are not as well understood as those of more common symptoms such as tinnitus.

The authors also noted that prolonged exposure to aspirin may be associated with more neurological symptoms. Chronic exposure could increase the likelihood that drugs cross the blood-brain barrier, the protective system that controls which substances in the blood enter the brain.

They recommended that physicians consider poisoning—including salicylate poisoning—when patients develop psychotic symptoms without an obvious cause.

What this case shows about aspirin safety

Taking more aspirin than directed can lead to serious poisoning, even when symptoms initially appear unusual or psychiatric. Tinnitus, rapid breathing, confusion, hallucinations and changes in alertness can all require urgent medical attention.

This article is for informational purposes only and does not provide medical advice.

Source

Meyers, J., McCormick, S., Levy, P. D., and Twiner, M. J. (2025). “I see dead people”: A case report of salicylic acid poisoning in a patient with hallucinations. Emergency Medicine Clinical Practice and Cases, 9(1).