Iron, salicylate and toxic alcohol poisoning

Your progress

Saved on this device.

Target exams

Red flags

• A child with a high-anion-gap metabolic acidosis plus radiopaque tablets on abdominal X-ray is iron-toxic: give intravenous desferrioxamine once serum iron over 500 microgram per dL, acidosis or shock is present, and never be reassured by the latent phase
• Mixed respiratory alkalosis plus high-anion-gap metabolic acidosis with tinnitus and hyperpnoea is salicylate toxicity: alkalinise the urine to pH 7.5 to 8.0 after correcting potassium, and dialyse at over 7.2 mmol per L (100 mg per dL, about 720 mg per L) or for CNS or pulmonary signs
• High-anion-gap acidosis PLUS elevated osmolal gap with visual symptoms or calcium oxalate crystalluria is a toxic alcohol: start intravenous fomepizole 15 mg per kg loading on suspicion and do NOT wait for methanol or ethylene glycol levels
• Loss of the hyperventilatory compensation after intubating a salicylate-toxic child causes rapid fatal acidosis: pre-oxygenase, give a bicarbonate bolus, and set the ventilator to maintain pre-intubation hypocapnia
• A normal osmolal gap late in the course does NOT exclude a toxic alcohol: the osmolal gap falls as the anion gap rises; treat on the clinical picture and the anion gap
• Methyl salicylate (oil of wintergreen) is highly concentrated: as little as 4 mL can kill a toddler; treat any ingestion as life-threatening
• Activated charcoal is useless for iron (a metal) and for toxic alcohols (small molecules); it adsorbs only salicylate
• Any child who may need dialysis, vasoactive support, mechanical ventilation or intensive care unavailable locally: call the poisons centre, senior, PICU or retrieval before local support is exceeded

Life stages

Care settings

Clinical exam formats

Board mappings

• Acute Care
• Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with potential cardiac, respiratory or neurological emergencies or acute sepsis
• Current 2026 PREP curriculum — Learning Objective 2.2.3: Perform acute resuscitation and advanced life support
• Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
• Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
• Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
• Clinical Applications
• Medical Sciences
• Long Cases
• Short Cases
• 4. Professional skills and knowledge: Patient management
• 7. Patient safety, including safe prescribing
• General Paediatrics: Resuscitates, stabilises and treats extremely unwell babies, children and young people, liaising with specialist teams, as necessary
• General Paediatrics: Assumes the role of Acute Paediatric Team Leader
• Applied Knowledge in Practice (AKP)
• Theory and Science (TAS)
• Clinical
• History
• Communication
• Video
• General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
• General Pediatrics Content Outline — Universal Task 4: Management and Treatment
• General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
• Patient Care 5: Patient Management
• Patient Care 4: Clinical Reasoning
• Systems-Based Practice 1: Patient Safety
• Medical Expert
• Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
• Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management