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Aspirin toxicity requiring alkalinisation — SCE Acute Medicine MCQ

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HardToxicology and OverdoseAspirin toxicity requiring alkalinisationSCE Acute Medicine

A 63-year-old woman is assessed on the acute medical unit. She has salicylate poisoning with confusion, tachypnoea and metabolic acidosis. Salicylate level is high and renal function is borderline. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: A — Start intravenous sodium bicarbonate for urinary alkalinisation

Start intravenous sodium bicarbonate for urinary alkalinisation is the best answer because alkalinisation reduces tissue salicylate penetration and enhances renal elimination in significant poisoning. Give broad-spectrum intravenous antibiotics within one hour is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Acidaemia is dangerous because it increases non-ionised salicylate entry into the brain.

Reference: Toxbase; BNF