NSAID toxicity: Difference between revisions

Latest revision as of 22:57, 7 March 2021

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

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Vast majority of pts w/ acute overdoses suffer little morbidity
+*Vast majority of patients with acute overdoses suffer little morbidity
-*Fatalities associated w/ massive ingestions w/ clinical features of AMS, metabolic acidosis, shock
+*Usually asymptomatic with ingestions <100mg/kg
-*Usually asymptomatic w/ ingestions <100mg/kg
+*Significant risk for toxicity with ingestions >400mg/kg
-*Significant risk for toxicity w/ ingestions >400mg/kg
+*Symptoms begin within 4hr of ingestion
-*Symptoms begin w/in 4hr of ingestion
 ==Clinical Features==
-#GI
+*GI
-##Abdominal pain, N/V
+**Abdominal pain, nausea and vomiting, hepatic injury, pancreatitis (rare)
-#CNS
+*CNS
-##HA, AMS, Coma
+**headache, altered mental status, nystagmus, diplopia, muscle twitching, seizures, coma
-#CV
+*CV
-##Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances)
+**Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances)
-#Electrolyte
+*Electrolyte
-##Hyperkalemia, hypocalcemia, hypomagnesemia
+**[[Hyperkalemia]], hypocalcemia, hypomagnesemia, AG metabolic acidosis
-##AG metabolic acidosis (metabolites are weak acids)
+*Renal
-#Renal
+**Renal insufficiency (rarely causes failure)
-##Renal insufficiency (rarely causes failure)
-==Work-Up==
+==Differential Diagnosis==
-#Chemistry
-#LFT
+==Evaluation==
-#CBC
+===Work-Up===
-#Coags
+*Chemistry
-#APAP/ASA levels
+*LFT
+*CBC
+*Coags
+*APAP/ASA levels
+===Diagnosis===
 ==Management==
-#Asymptomatic
+===Asymptomatic===
-##Rule-out coingestants, observe for 4hr
+*Rule-out coingestants, observe for 4hr
-#Symptomatic
-##GI decontamination
+===Symptomatic===
-###Consider whole-bowel irrigation for enteric-coated formulations
+*GI decontamination
-##Hypotension
+**Consider [[whole-bowel irrigation]] for enteric-coated formulations
-###IVF and pressors as needed
+*Hypotension
-##Dialysis ineffective
+**[[IVF]] and [[pressors]] as needed
+*Dialysis ineffective
 ==Disposition==
-*Consider d/c if asymptomatic after 4-6hr obs
+*Consider discharge if asymptomatic after 4-6hr obs
+==See Also==
+*[[Acetaminophen (tylenol) toxicity]]
+*[[Aspirin (Salicylate) Toxicity]]
+*[[NSAIDs]]
+*[[Toxicology (Main)]]
+==References==
+<references/>
-==Source==
-*Tintinalli
-[[Category:Tox]]
+[[Category:Toxicology]]