Paediatric emergencies: salicylate poisoning: practice question

A Pediatrics 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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Pediatrics · Paediatric emergencies: salicylate poisoning

Sample item

A 3-year-old ingested several tablets of her grandmother's aspirin. She has vomiting, tinnitus, fever and rapid deep breathing. Which blood gas pattern is typical?

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

The answer and the reasoning

A. Respiratory alkalosis plus anion gap acidosis

Salicylates stimulate the respiratory centre, causing early respiratory alkalosis, and uncouple oxidative phosphorylation, causing high anion gap metabolic acidosis from lactate and ketones. Young children often present with acidosis dominant. Treatment is activated charcoal, intravenous sodium bicarbonate to alkalinise the urine, and dialysis in severe cases.

Option by option

  • A. Respiratory alkalosis plus anion gap acidosis (correct)

    Correct. A mixed respiratory alkalosis with high anion gap acidosis is characteristic.

  • B. Pure metabolic alkalosis

    Metabolic alkalosis does not occur in this poisoning.

  • C. Normal anion gap metabolic acidosis

    The acidosis from uncoupling and lactate increases the anion gap, so it is not a normal anion gap acidosis.

  • D. Pure respiratory acidosis

    Respiratory depression is not an early feature, and acidosis would not be purely respiratory.

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 Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Respiratory alkalosis plus anion gap acidosis. Salicylates stimulate the respiratory centre, causing early respiratory alkalosis, and uncouple oxidative phosphorylation, causing high anion gap metabolic acidosis from lactate and ketones.

Why is "Pure metabolic alkalosis" not the answer?

Metabolic alkalosis does not occur in this poisoning.

Why is "Normal anion gap metabolic acidosis" not the answer?

The acidosis from uncoupling and lactate increases the anion gap, so it is not a normal anion gap acidosis.

Why is "Pure respiratory acidosis" not the answer?

Respiratory depression is not an early feature, and acidosis would not be purely respiratory.

What concept does this question test?

It tests Paediatric emergencies: salicylate poisoning in Pediatrics. Young children often present with acidosis dominant. Treatment is activated charcoal, intravenous sodium bicarbonate to alkalinise the urine, and dialysis in severe cases.

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 Paediatric emergencies: salicylate poisoning?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.