NSAID toxicity: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*GI | *GI | ||
**Abdominal pain, N/V | **Abdominal pain, N/V, hepatic injury, pancreatitis (rare) | ||
*CNS | *CNS | ||
**HA, AMS, coma | **HA, AMS, nystagmus, diplopia, muscle twitching, seizures, coma | ||
*CV | *CV | ||
**Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances) | **Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances) | ||
Revision as of 18:08, 6 June 2014
Background
- Vast majority of pts w/ acute overdoses suffer little morbidity
- Usually asymptomatic w/ ingestions <100mg/kg
- Significant risk for toxicity w/ ingestions >400mg/kg
- Symptoms begin within 4hr of ingestion
Clinical Features
- GI
- Abdominal pain, N/V, hepatic injury, pancreatitis (rare)
- CNS
- HA, AMS, 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
- Chemistry
- LFT
- CBC
- Coags
- APAP/ASA levels
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
- GI decontamination
Disposition
- Consider d/c if asymptomatic after 4-6hr obs
Source
- Tintinalli