Sun14November1246PM 24

A 70-year-old female is admitted 12 hours after taking an overdose of aspirin.

Investigations revealed:

Serum sodium 138 mmol/L (137-144)

Serum potassium 5.9 mmol/L (3.5-4.9)

Serum bicarbonate 14 mmol/L (20-28)

Serum urea 18.1 mmol/L (2.5-7.5)

Serum creatinine 238 mol/L (60-110)

Serum salicylate 1120 mg/L (8)

Which option is the most appropriate treatment of this patient?

(Please select 1 option)

Intravenous sodium bicarbonate

Urine alkalinisation Incorrect answer selected

Haemodialysis This is the correct answer

Peritoneal dialysis

Haemofiltration

Explanation

This patient is at major risk of aspirin toxicity as reflected by the excessive aspirin concentration and appears to have developed acute renal failure - she is acidotic with an elevated potassium.

Bicarbonate is recommended as a supportive therapy but in this patient haemodialysis is the treatment of choice. The latter is advised when the plasma-salicylate concentration is greater than 700 mg/litre (5.1 mmol/litre) or in the presence of severe metabolic acidosis as recommended within the British National Formulary (BNF) poisons section.

There is nothing wrong with haemofiltration; it just removes the toxin more slowly.

Answer Statistics

1

13%

2

15%

3

47%

4

26%

Times answered: 261