Following an overdose of an over-the-counter (OTC) drug, a young college student has marked GI distress and is lethargic and confused, with elevated body temperature. Lab analysis of blood reveals |pCO2--|HCO3---|K+and an anion gap acidosis. The most likely cause of these signs and symptoms is a toxic dose of

If the patient had been able to mention tinnitus, this would be a classic case of aspirin poisoning. At high salicylate blood levels, the combination of effects leading to respiratory depression (respiratory acidosis) and metabolic acidosis results in the observed pH and electrolyte changes, the anion gap (a marker for acidosis), and hyperthermia.