The patient admits to ingesting aspirin 30 mins ago, so he is in the early stages of salicylate toxicity

and there has not yet been time for renal compensation. Since aspirin is acidic, one would expect it
to cause a metabolic acidosis, but the reality is that aspirin is a very weak acid that has relatively
little direct effect on acid load, at least initially. Instead it stimulates the respiratory centers and
increases ventilation, causing the patient to “blow off” CO2 to produce the respiratory alkalosis
described in the Davenport diagram. The only point on the figure with lower PaCO2 and no
compensation is choice E. Note that the respiratory center effect is seen even at normal therapeutic
doses.
Aspirin uncouples oxidative phosphorylation, so the respiratory alkalosis transitions to a mixed
acid-base disorder (respiratory alkalosis + metabolic acidosis) as lactate and ketoacid levels begin
to build.
Since aspirin is a relatively weak acid, it readily crosses the blood-brain barrier. At toxic levels,
aspirin causes cerebral edema and central respiratory paralysis. The ensuing drop in ventilatory
drive causes respiratory acidosis (+ metabolic acidosis) and may ultimately prove lethal in the
absence of timely medical intervention.
Choice A represents metabolic alkalosis with partial respiratory compensation.
Choice B represents respiratory acidosis with partial renal compensation.
Choice C represents metabolic acidosis without respiratory compensation and would be more
likely in chronic salicylate poisoning.
An 18-year-old college student is brought to the emergency department by his roommate who found
him complaining of epigastric pain and nausea. The roommate had noticed an empty bottle of aspirin
near the patient. Upon questioning, the patient admits to ingesting the contents of the bottle half an
hour ago. Which of the following letters on the Davenport diagram accurately describes the status of
this patient with acute aspirin poisoning?
Salicylates cause an acute respiratory alkalosis. Davenport diagrams (such as the one above)
can be useful learning tools for evaluating and understanding the how acid-base disturbances
manifest as they do and the processes involved in compensation.
Davenport diagrams show the relationship between plasma pH and HCO3−, a relationship described
by theHenderson-Hasselbalch equation. Changes in ventilation modify PaCO2 and cause plasma pH
and HCO3− to shift in a predictable fashion, represented by the orange lines in the diagrams (figure
at left shows effects of immediate change that have not allowed time for compensation).
Changes in non-volatile acid levels also affect plasma pH and HCO3− in a predictable fashion, as
represented by the purple lines. The figure at right shows how normal changes in ventilation or
renal function help compensate for such disturbances and renormalize plasma pH.

Choice D represents metabolic acidosis with partial respiratory compensation, which may be
observed after the acute stage of the poisoning.