Problems for Discussion - 1 - Salicylates

• Understand the mechanism and treatment of salicylate poisoning
• Understand effects of urinary alkalinisation

An 18-year-old girl, 60 kg, 5 hours previously ingested 80 x 300 mg soluble aspirin washed down with a large amount of cheap wine. She is nauseated, vomiting complains of buzzing in her ears. Drowsy but responds purposefully. Pulse 120, BP 105/60, RR 18.

You order some investigations

• Breath Alcohol 0.16
• Glucose 6.4 mmol/L
• ABGs
  • pH 7.32
  • pCOB2B 28
  • pOB2B 112
  • HCOB3B 13
• Electrolytes Normal
• Urine pH 6

1. Would you decontaminate her?
2. Discuss her management, detailing your interventions and how you would monitor therapy.
3. What is the implication of co-ingestion of alcohol (or other sedatives) in this situation?