1. Severe respiratory alkalosis.
2. Mixed metabolic acidosis respiratory alkalosis.
3. Hyperchloremic metabolic acidosis.
Select the correct answer using the code given below
Salicylate Intoxication Acid-Base Disturbances
Salicylate intoxication in adults typically presents with characteristic acid-base disturbances due to its complex effects on respiration and cellular metabolism.
Respiratory Alkalosis in Salicylate Intoxication
Salicylates directly stimulate the brainstem's respiratory center. This stimulation causes patients to breathe faster and deeper (hyperventilation), leading to increased elimination of carbon dioxide ($CO_2$) from the blood.
- This results in lower blood $CO_2$ levels (hypocapnia).
- Consequently, the blood pH increases, causing respiratory alkalosis.
- This aligns with statement 1.
Metabolic Acidosis in Salicylate Intoxication
As salicylate levels rise or intoxication progresses, salicylates disrupt cellular energy production (uncoupling oxidative phosphorylation). This metabolic derangement leads to the buildup of organic acids, such as lactic acid and ketoacids, in the body.
- These accumulating acids consume the body's bicarbonate ($HCO_3^-$) buffer.
- This results in a decrease in blood pH and bicarbonate levels, causing metabolic acidosis.
- The metabolic acidosis in salicylate poisoning is typically a high anion gap metabolic acidosis, not the hyperchloremic type mentioned in statement 3.
Mixed Disorder in Salicylate Intoxication
Given the dual effects of salicylates, adults with significant intoxication often exhibit both respiratory alkalosis and metabolic acidosis simultaneously.
- The initial respiratory alkalosis can persist alongside the developing metabolic acidosis.
- This combination is accurately described as a mixed metabolic acidosis respiratory alkalosis.
- This confirms statement 2 is correct.
Summary of Salicylate Disturbances
Considering the physiological effects:
- Statement 1 (Severe respiratory alkalosis) occurs due to initial respiratory center stimulation.
- Statement 2 (Mixed metabolic acidosis respiratory alkalosis) represents the common advanced or significant clinical picture.
- Statement 3 (Hyperchloremic metabolic acidosis) is not the characteristic metabolic disturbance.
Therefore, statements 1 and 2 are the most accurate descriptions of disturbances usually caused by salicylate intoxication in adults.
Important Questions from Acid-Base Disorders
- The most common acid-base disturbance in critically ill patients is :
- Which one of the following pairs is not correctly matched?
Consider the following:
1. Normal anion gap
2. Hyperchloraemic acidosis
3. Inappropriately high urinary pH (>5.4)
Which of the above are the characteristic features of renal tubular acidosis (RTA)?- Which one of the following is not an example of metabolic acidosis with high anion gap?
- Consider the following statements regarding distal renal tubular acidosis:
1. Blood biochemistry reveals normal anion gap metabolic acidosis
2. There is defective secretion of H$^+$ in the distal tubule.
3. There may be associated muscle weakness and rickets.
4. Children may present with polydipsia and polyuria.
Which of the above statements are correct?
