Paracetamol and Salicylate Poisoning

A 28-year-old woman is brought to the emergency department 6 hours after ingesting approximately 15 g of paracetamol in a suicide attempt. She is currently asymptomatic with normal vital signs. Physical examination is unremarkable. Blood investigations show: AST 45 U/L, ALT 52 U/L, bilirubin 0.9 mg/dL, INR 1.0, serum paracetamol level 180 µg/mL. What is the most appropriate next step in management?

Which metabolite of paracetamol is responsible for hepatotoxicity in overdose?

In salicylate poisoning, which acid-base disturbance occurs first, followed by a mixed picture?

A 62-year-old man with chronic pain is admitted with altered mental status, tachypnea (RR 32/min), and fever (38.5°C). He admits to taking large quantities of aspirin for the past 3 days. Arterial blood gas shows: pH 7.28, PaCO₂ 24 mmHg, HCO₃⁻ 11 mEq/L, PaO₂ 95 mmHg on room air. Serum salicylate level is 65 mg/dL. What is the primary acid-base disturbance in this patient?