Salicylate ingestion typically leads to which type of acid-base disorder?

Salicylate ingestion is associated with a unique acid-base disturbance primarily due to its various pharmacological effects at different doses. Initially, after acute salicylate ingestion, one of the key changes is a primary respiratory alkalosis caused by the direct stimulation of the central respiratory centers, leading to hyperventilation and subsequent loss of carbon dioxide.

As the salicylate level increases, there is an accumulation of organic acids which contributes to a metabolic acidosis. This metabolic acidosis can be characterized by an elevated anion gap due to the presence of unmeasured anions, such as lactate, that accumulate as a result of tissue metabolism and the effects of salicylate on cellular respiration.

The combination of the initial respiratory alkalosis and the resulting metabolic acidosis leads to a clinical picture that includes both types of acid-base disorders. The presence of metabolic acidosis (with an increased anion gap) coupled with primary respiratory alkalosis is a classic finding in salicylate toxicity. Thus, the correct understanding of the pathology involved solidifies why the answer includes both anion gap acidosis and primary respiratory alkalosis.