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Toxicology – Nonsteroidal Anti-Inflammatory Drug (NSAID) Toxicity
Source
NSAIDs are widely used medications for pain relief, inflammation, and fever reduction. Ibuprofen is the most commonly encountered agent. Other examples include diclofenac, naproxen, indomethacin, ketorolac, meloxicam, and sulindac.
Typical Presentation
Most cases involve mild overdose, often in young individuals, presenting with gastrointestinal discomfort. Severe toxicity is uncommon but may occur with large ingestions.
Clinical Features
Symptoms are usually mild and include abdominal pain, nausea, and vomiting. Occasionally, patients may develop gastrointestinal bleeding. In more severe overdoses, complications can include acute kidney injury, hyperkalemia, tinnitus, seizures, coma, or cardiovascular collapse. Symptoms typically begin within a few hours of ingestion and resolve within 24 hours in uncomplicated cases.
Mechanism of Action
NSAIDs inhibit cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin production. While this provides therapeutic effects, it can also impair kidney function and damage the gastrointestinal lining, especially with high doses or prolonged use.
Management
Treatment is supportive. Intravenous fluids and antiemetics are commonly used. There is no specific antidote. Patients with mild symptoms and stable vital signs may be observed for several hours and discharged if no complications develop.
Key Points
Source
NSAIDs are widely used medications for pain relief, inflammation, and fever reduction. Ibuprofen is the most commonly encountered agent. Other examples include diclofenac, naproxen, indomethacin, ketorolac, meloxicam, and sulindac.
Typical Presentation
Most cases involve mild overdose, often in young individuals, presenting with gastrointestinal discomfort. Severe toxicity is uncommon but may occur with large ingestions.
Clinical Features
Symptoms are usually mild and include abdominal pain, nausea, and vomiting. Occasionally, patients may develop gastrointestinal bleeding. In more severe overdoses, complications can include acute kidney injury, hyperkalemia, tinnitus, seizures, coma, or cardiovascular collapse. Symptoms typically begin within a few hours of ingestion and resolve within 24 hours in uncomplicated cases.
Mechanism of Action
NSAIDs inhibit cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin production. While this provides therapeutic effects, it can also impair kidney function and damage the gastrointestinal lining, especially with high doses or prolonged use.
Management
Treatment is supportive. Intravenous fluids and antiemetics are commonly used. There is no specific antidote. Patients with mild symptoms and stable vital signs may be observed for several hours and discharged if no complications develop.
Key Points
- Most acute NSAID overdoses are mild and self-limiting.
- Serious toxicity is more likely with very high doses (e.g., >400 mg/kg).
- Use caution in elderly patients and those with kidney disease, even at normal doses.
- Chronic overuse increases the risk of gastrointestinal bleeding and renal injury.
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