NSAID toxicity

Background

• Vast majority of pts w/ acute overdoses suffer little morbidity
• Fatalities associated w/ massive ingestions w/ clinical features of AMS, metabolic acidosis, shock
• Usually asymptomatic w/ ingestions <100mg/kg
• Significant risk for toxicity w/ ingestions >400mg/kg
• Symptoms begin w/in 4hr of ingestion

Clinical Features

1. GI
   1. Abdominal pain, N/V
2. CNS
   1. HA, AMS, Coma
3. CV
   1. Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances)
4. Electrolyte
   1. Hyperkalemia, hypocalcemia, hypomagnesemia
   2. AG metabolic acidosis (metabolites are weak acids)
5. Renal
   1. 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 d/c if asymptomatic after 4-6hr obs

Source

• Tintinalli