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Salicylate toxicity — ABEM Board MCQ

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HardToxicologySalicylate toxicityABEM Board

A 33-year-old man arrives as ESI 2 after taking aspirin tablets for tinnitus. BP 118/72, HR 124, RR 32. ABG shows pH 7.48, PCO2 22 mm Hg, bicarbonate 16 mEq/L; salicylate level is elevated. Which of the following is the most appropriate next step in management?

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Correct answer: A — Begin serum and urine alkalinization with sodium bicarbonate

Salicylate toxicity produces mixed respiratory alkalosis and metabolic acidosis; bicarbonate alkalinization enhances elimination and reduces CNS penetration.

Reference: ACMT salicylate poisoning guidance; Goldfrank Toxicologic Emergencies