What therapy can be considered to enhance the elimination of salicylate without impacting phenytoin levels?

Urinary alkalinization is the most effective therapy for enhancing the elimination of salicylate. This process involves administering sodium bicarbonate, which increases the pH of the urine, leading to a more ionized form of salicylate. The ionized form is less readily reabsorbed in the renal tubules, promoting increased excretion through the urine.

This method is particularly useful because it selectively enhances salicylate elimination while having minimal effects on other medications, including phenytoin. Phenytoin, being a weak acid, is primarily eliminated through hepatic metabolism. Urinary alkalinization does not significantly change the renal handling or blood levels of phenytoin, making it a suitable choice in scenarios involving patients on phenytoin therapy.

The other options, while relevant in certain contexts, do not provide the same targeted benefit for salicylate elimination without influencing phenytoin levels. For instance, multiple doses of activated charcoal can bind salicylate and reduce absorption but do not affect excretion, and whole bowel irrigation is not specific to salicylate and could disrupt the absorption of phenytoin. Urinary acidification, on the other hand, would decrease salicylate