Salicylate poisoning — ESENeph MCQ

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HardAcute Kidney Injury, Electrolytes and Acid-BaseSalicylate poisoningESENeph

A 45-year-old woman presents 8 hours after a large aspirin overdose. She is tachypnoeic and confused; ABG shows pH 7.48, PaCO2 2.8 kPa, bicarbonate 16 mmol/L and lactate 3 mmol/L. Salicylate concentration is high and rising despite activated charcoal. What is the most appropriate management?

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Correct answer: A — Alkalinise urine and discuss urgent haemodialysis

Salicylate poisoning causes mixed respiratory alkalosis and metabolic acidosis; severe or rising levels with neurological symptoms require urinary alkalinisation and urgent toxicology/nephrology discussion for haemodialysis. Suppressing tachypnoea can worsen acidaemia and increase CNS salicylate entry. Acetazolamide would worsen metabolic acidosis. The pearl is that apparent alkalosis does not reassure in salicylate toxicity because falling pH increases tissue toxicity. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: TOXBASE principles; KDIGO AKI supportive care: https://www.nice.org.uk/guidance/ng148/chapter/recommendations