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Severe salicylate poisoning — RCPSC IM MCQ

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HardCritical CareSevere salicylate poisoningRCPSC IM

A 33-year-old after a large salicylate ingestion has tinnitus, agitation, pulmonary edema, acute kidney injury, acidemia despite bicarbonate therapy and a rising level. What is the most appropriate escalation?

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Correct answer: B — Arrange hemodialysis while continuing bicarbonate alkalinization

The best answer is “Arrange hemodialysis while continuing bicarbonate alkalinization”. Pulmonary edema, kidney injury, worsening acid-base status and clinical toxicity are indications for urgent extracorporeal removal. Alkalinization continues while dialysis is mobilized. Delay is dangerous, and intubation can worsen toxicity if the compensatory high minute ventilation is lost.

Reference: Ontario Poison Centre, clinical resources and protocols: https://www.ontariopoisoncentre.ca/health-care-professionals/clinical-resources-and-protocols/