NSAID toxicity: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
===Work-Up=== | ===Work-Up=== | ||
*Chemistry | |||
*LFT | |||
*CBC | |||
*Coags | |||
*APAP/ASA levels | |||
===Diagnosis=== | ===Diagnosis=== | ||
| Line 35: | Line 35: | ||
===Symptomatic=== | ===Symptomatic=== | ||
*GI decontamination | *GI decontamination | ||
**Consider whole-bowel irrigation for enteric-coated formulations | **Consider [[whole-bowel irrigation]] for enteric-coated formulations | ||
*Hypotension | *Hypotension | ||
**IVF and pressors as needed | **[[IVF]] and [[pressors]] as needed | ||
*Dialysis ineffective | *Dialysis ineffective | ||
Latest revision as of 22:57, 7 March 2021
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)
Differential Diagnosis
Evaluation
Work-Up
- Chemistry
- LFT
- CBC
- Coags
- APAP/ASA levels
Diagnosis
Management
Asymptomatic
- Rule-out coingestants, observe for 4hr
Symptomatic
- GI decontamination
- Consider whole-bowel irrigation for enteric-coated formulations
- Hypotension
- Dialysis ineffective
Disposition
- Consider discharge if asymptomatic after 4-6hr obs