NSAID toxicity: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Vast majority of pts w/ acute overdoses suffer little morbidity | *Vast majority of pts w/ acute overdoses suffer little morbidity | ||
*Usually asymptomatic w/ ingestions <100mg/kg | *Usually asymptomatic w/ ingestions <100mg/kg | ||
*Significant risk for toxicity w/ ingestions >400mg/kg | *Significant risk for toxicity w/ ingestions >400mg/kg | ||
*Symptoms begin | *Symptoms begin within 4hr of ingestion | ||
==Clinical Features== | ==Clinical Features== | ||
*GI | *GI | ||
*CNS | **Abdominal pain, N/V | ||
*CV | *CNS | ||
*Electrolyte | **HA, AMS, coma | ||
*Renal | *CV | ||
**Hypotension, shock, bradydysrhythmia (due to electrolyte imbalances) | |||
*Electrolyte | |||
**Hyperkalemia, hypocalcemia, hypomagnesemia, AG metabolic acidosis | |||
*Renal | |||
**Renal insufficiency (rarely causes failure) | |||
==Work-Up== | ==Work-Up== | ||
Revision as of 07:54, 28 January 2012
Background
- Vast majority of pts 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
- CNS
- HA, AMS, 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 d/c if asymptomatic after 4-6hr obs
Source
- Tintinalli