Toxicology: salicylate poisoning: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Toxicology: salicylate poisoning

Sample item

A 3-year-old child who swallowed oil of wintergreen has tinnitus, vomiting, fever and fast deep breathing. Which acid-base pattern is expected, and what is the key treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Respiratory alkalosis with anion gap acidosis; urinary alkalinisation

Salicylates stimulate the respiratory centre, causing respiratory alkalosis, and uncouple oxidative phosphorylation, causing an anion gap metabolic acidosis; children tend to be acidotic early. Intravenous sodium bicarbonate alkalinises urine and traps salicylate for excretion, and haemodialysis is used for severe toxicity. Intubation is hazardous because loss of the respiratory drive worsens acidosis.

Option by option

  • A. Respiratory alkalosis with anion gap acidosis; urinary alkalinisation (correct)

    Correct. Mixed disturbance with bicarbonate-induced urinary alkalinisation is the standard approach.

  • B. Pure metabolic alkalosis; intravenous saline

    Metabolic alkalosis is not a feature of salicylate toxicity.

  • C. Normal anion gap acidosis; oral bicarbonate

    The acidosis has a raised anion gap because of accumulated organic acids.

  • D. Pure respiratory acidosis; mechanical ventilation

    Respiratory acidosis does not fit the hyperventilation seen early.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is A, Respiratory alkalosis with anion gap acidosis; urinary alkalinisation. Salicylates stimulate the respiratory centre, causing respiratory alkalosis, and uncouple oxidative phosphorylation, causing an anion gap metabolic acidosis; children tend to be acidotic early.

Why is "Pure metabolic alkalosis; intravenous saline" not the answer?

Metabolic alkalosis is not a feature of salicylate toxicity.

Why is "Normal anion gap acidosis; oral bicarbonate" not the answer?

The acidosis has a raised anion gap because of accumulated organic acids.

Why is "Pure respiratory acidosis; mechanical ventilation" not the answer?

Respiratory acidosis does not fit the hyperventilation seen early.

What concept does this question test?

It tests Toxicology: salicylate poisoning in Forensic Medicine. Intravenous sodium bicarbonate alkalinises urine and traps salicylate for excretion, and haemodialysis is used for severe toxicity. Intubation is hazardous because loss of the respiratory drive worsens acidosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: salicylate poisoning?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.