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, 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

See Also

References