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

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

Source

• Tintinalli