Treatment of Respiratory Alkalosis in Salicylate Poisoning with Increased Anion Gap Metabolic Acidosis

When respiratory alkalosis occurs alongside an increased anion gap metabolic acidosis, salicylate poisoning must be promptly considered. This combination of acid-base disturbances is a recognized presentation of salicylate toxicity and guides the clinical response.

Clinical Scenario

This protocol addresses patients with salicylate poisoning who present with respiratory alkalosis and a concurrent increased anion gap metabolic acidosis. This acid-base pattern is characteristic and should trigger urgent evaluation for salicylate toxicity.

Treatment Goals

The primary clinical targets are correction of systemic acidemia and achieving an alkaline urine pH. Reaching these endpoints is central to the management of this presentation.

Approach Overview

Management is directed at addressing systemic acidemia, when present, and at alkalinizing the urine. The complete regimen — including specific interventions, sequencing, monitoring thresholds, and decision points — is available in the full structured protocol.

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References

DOI: 10.1053/j.ajkd.2023.02.004

Unexplained respiratory alkalosis, particularly in association with an increased anion gap metabolic acidosis, should prompt consideration of salicylate poisoning.

The initial goal of therapy is to correct systemic acidemia if present and to alkalinize the urine pH.

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