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Severe salicylate toxicity — ABEM Board MCQ

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HardToxicologySevere salicylate toxicityABEM Board

A 35-year-old man presents as triage level 1 with tinnitus, vomiting, fever, and confusion after ingesting aspirin. ABG shows pH 7.49, PaCO2 18 mm Hg; BMP shows bicarbonate 12 mEq/L and anion gap 24; salicylate level is 92 mg/dL. Which of the following is the most important immediate intervention?

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Correct answer: B — IV sodium bicarbonate and emergent hemodialysis consultation

Severe salicylate poisoning with altered mental status, high level, and mixed respiratory alkalosis/metabolic acidosis requires alkalinization and dialysis planning.

Reference: ACMT salicylate poisoning guidance; ABEM EM Model