A 15-year-old girl with a history of depression and self-harm is found surrounded by empty pill bottles approximately 1 hour after ingestion. She admits to taking approximately 25 tablets of aspirin (acetylsalicylic acid) 325 mg (135 mg/kg), 2,000 mg of ibuprofen, and “a few stomach pills” with the intent to commit suicide. Two hours after ingestion, she notes abdominal pain but is otherwise alert, oriented, and breathing comfortably at a community hospital. Her initial serum salicylate level is 32.5 mg/dL 4 hours after ingestion. She is transferred to a tertiary facility, where she notes abdominal pain, nausea, and now ringing in her ears.

On examination, she has a temperature of 97.8°F (36.6°C), blood pressure of 101/60 mm Hg, pulse of 112 beats/min, and respiratory rate of 18 breaths/min. She answers questions appropriately. Abdominal examination elicits diffuse mild tenderness, normal bowel sounds, and no masses. Motor and sensory examination findings are...

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