A 75-year-old woman with rheumatoid arthritis (RA) takes aspirin for symptom control. She usually adjusts the dose of her own medications depending on how she is feeling.For the above patient with a toxic ingestion or exposure, select the most likely clinical effect.

Salicylates are associated with vertigo, hyperventilation, tinnitus, and deafness. Excretion of salicylates is renal, and in the presence of normal renal function, about 50% will be excreted in 24 hours. Severe toxicity can cause severe acid-base abnormalities. It can be difficult to diagnose when the toxicity is secondary to a therapeutic regimen.