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Severe salicylate poisoning — RCPSC EM MCQ

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HardToxicologySevere salicylate poisoningRCPSC EM

A 48-year-old has tinnitus, vomiting, and confusion after aspirin ingestion. RR is 34/min, pH is 7.31, PaCO2 is 20 mmHg, bicarbonate is 10 mmol/L, creatinine is rising, and salicylate level is 6.8 mmol/L. What is the most appropriate next step?

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

Start urinary alkalinisation and arrange urgent haemodialysis is correct: the clues indicate Severe salicylate poisoning and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Goldfrank's Toxicologic Emergencies; Canadian poison centre practice