skip to main content

Severe salicylate poisoning — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardToxicology and OverdoseSevere salicylate poisoningSCE Acute Medicine

A 27-year-old man presents with tinnitus, vomiting and agitation after taking aspirin. Respiratory rate is 34/min and temperature is 38.5°C. ABG shows pH 7.48, PaCO2 2.8 kPa, bicarbonate 16 mmol/L and lactate 2.5 mmol/L. Salicylate concentration is 760 mg/L. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Start urinary alkalinisation and discuss urgent haemodialysis

This is severe salicylate poisoning with mixed respiratory alkalosis and metabolic acidosis physiology, needing alkalinisation and early dialysis discussion. Suppressing respiratory drive can cause abrupt acidaemia and increased CNS salicylate penetration. NAC is for paracetamol toxicity, not aspirin poisoning. The pearl is that the apparently alkalotic pH can mask severe toxicity.

Reference: TOXBASE; NPIS guidance; BNF poisoning summary