NSAID toxicity

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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, 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

  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

References

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