A patient with delayed salicylate poisoning has confusion, pulmonary edema, creatinine 210 µmol/L, pH 7.40 with mixed respiratory alkalosis and

Question

A patient with delayed salicylate poisoning has confusion, pulmonary edema, creatinine 210 µmol/L, pH 7.40 with mixed respiratory alkalosis and metabolic acidosis, and a level of 3.1 mmol/L. What is the priority plan?

Accepted Answer

Start bicarbonate alkalinization and arrange urgent dialysis with poison-centre input

Answer

Observe because a normal pH excludes clinically important tissue salicylate exposure

Answer

Intubate immediately to a normal PaCO2 before giving bicarbonate or consulting dialysis

Answer

Use repeated activated charcoal as sole therapy until the level falls below 2.9 mmol/L

Answer

Give acetazolamide to alkalinize urine while avoiding systemic sodium administration

Salicylate poisoning — RCPSC EM MCQ

A patient with delayed salicylate poisoning has confusion, pulmonary edema, creatinine 210 µmol/L, pH 7.40 with mixed respiratory alkalosis and metabolic acidosis, and a level of 3.1 mmol/L. What is the priority plan?