NSAID toxicity: Difference between revisions
(Text replacement - "*Hyperkalemia" to "*Hyperkalemia") |
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**Renal insufficiency (rarely causes failure) | **Renal insufficiency (rarely causes failure) | ||
==Work-Up== | ==Differential Diagnosis== | ||
==Evaluation== | |||
===Work-Up=== | |||
#Chemistry | #Chemistry | ||
#LFT | #LFT | ||
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#Coags | #Coags | ||
#APAP/ASA levels | #APAP/ASA levels | ||
===Diagnosis=== | |||
==Management== | ==Management== | ||
===Asymptomatic=== | |||
*Rule-out coingestants, observe for 4hr | |||
===Symptomatic=== | |||
*GI decontamination | |||
**Consider whole-bowel irrigation for enteric-coated formulations | |||
*Hypotension | |||
**IVF and pressors as needed | |||
*Dialysis ineffective | |||
==Disposition== | ==Disposition== | ||
Revision as of 17:54, 1 June 2017
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
- IVF and pressors as needed
- Dialysis ineffective
Disposition
- Consider discharge if asymptomatic after 4-6hr obs