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Salicylate poisoning — SCE Acute Medicine MCQ

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HardToxicology and OverdoseSalicylate poisoningSCE Acute Medicine

A 82-year-old man presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show tinnitus, hyperventilation and mixed respiratory alkalosis with metabolic acidosis. What is the most appropriate next step in management?

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Correct answer: E — Start urinary alkalinisation with intravenous sodium bicarbonate and discuss haemodialysis criteria

The key discriminator is that tinnitus, hyperventilation and mixed respiratory alkalosis with metabolic acidosis, which makes Start urinary alkalinisation with intravenous sodium bicarbonate and discuss haemodialysis criteria the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Give targeted antidote or reversal therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF