NSAID toxicity

Background

• Vast majority of patients with acute overdoses suffer little morbidity
• Usually asymptomatic with ingestions <100mg/kg
• Significant risk for toxicity with ingestions >400mg/kg
• Symptoms begin within 4hr of ingestion

Clinical Features

• GI
  • Abdominal pain, nausea and vomiting, hepatic injury, pancreatitis (rare)
• CNS
  • headache, altered mental status, nystagmus, diplopia, muscle twitching, seizures, coma
• CV
  • Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances)
• Electrolyte
  • Hyperkalemia, hypocalcemia, hypomagnesemia, AG metabolic acidosis
• Renal
  • Renal insufficiency (rarely causes failure)

Work-Up

1. Chemistry
2. LFT
3. CBC
4. Coags
5. APAP/ASA levels

Management

1. Asymptomatic
   1. Rule-out coingestants, observe for 4hr
2. Symptomatic
   1. GI decontamination
      1. Consider whole-bowel irrigation for enteric-coated formulations
   2. Hypotension
      1. IVF and pressors as needed
   3. Dialysis ineffective

Disposition

• Consider discharge if asymptomatic after 4-6hr obs

See Also

• Acetaminophen (tylenol) toxicity
• Aspirin (Salicylate) Toxicity
• NSAIDs
• Toxicology (Main)

References

Authors

Jordan Swartz, Ross Donaldson, Silas Chiu, Neil Young, Daniel Ostermayer