NSAID toxicity: Difference between revisions
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Revision as of 19:30, 27 June 2016
Background
- Vast majority of patients 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 discharge if asymptomatic after 4-6hr obs