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Salicylate toxicity — MCCQE Part 1 MCQ

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HardPoisoning/OverdoseSalicylate toxicityMCCQE Part 1

27-year-old woman presents with tinnitus, vomiting and tachypnoea after overdose. ABG shows mixed respiratory alkalosis and metabolic acidosis. Which of the following is the most appropriate next step?

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Correct answer: B — Give activated charcoal if appropriate, alkalinise serum/urine and consult poison centre

Give activated charcoal if appropriate, alkalinise serum/urine and consult poison centre is best because salicylate toxicity has characteristic mixed acid-base disorder. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Falling salicylate level can be misleading if acidosis worsens CNS penetration.

Reference: Canadian poison centre guidance