Nonsteroidal Anti-inflammatory Drug NSAID poisoning

  • See also: See also Poisoning - Acute guidelines for Initial Management  

    Background to condition:  

    NSAIDs include celecoxib, diclofenac, etoricoxib, ibuprofen, indomethacin, ketoprofen, ketorolac, mefenamic acid, meloxicam, naproxen, parecoxib, piroxicam, sulindac, tiaprofenic acid.

    Note: this guideline does not cover aspirin. Please see Aspirin guideline

    How to assess:

    Generally benign in overdose.

    Massive ingestions can cause shock, coma, seizures, acute renal failure

    Symptoms:

    GIT: Epigastric pain, nausea, vomiting

    CNS: Drowsiness, lethargy, seizures

    Severity:

    Ibuprofen is very popular medication and readily available:  

    Ibuprofen dosage Clinical effects
    <200mg/kg Asymptomatic
    200-400mg/kg Mild GI and CNS effects
    >400mg/kg Risk of multi-organ dysfunction


    Mefenamic acid ingestion of >3.5g can cause seizures.    

    Management:  

    Indications for admission for observation:  

    • All symptomatic patients
    • Acute ingestion of ibuprofen 200 ≥mg/kg
    • All intentional overdose
    • Patients with concurrent illnesses  

    If any of the above, contact poisons information 13 11 26  

    Acute management  

    • Consider paracetamol ingestion in all deliberate self-poisonings.
    • Activated charcoal is not indicated.
    • Ensure adequate hydration after large overdoses to reduce the likelihood of acute renal failure.
    • Check FBE, U&Es, LFTs in symptomatic patients or those with concurrent illnesses. If any abnormality contact poisons information.
    • Use a proton pump inhibitor for epigastric pain.
    • Treat seizures as per seizure guideline.    

    Discharge requirements:  

    • Asymptomatic patients with normal vital signs 4 hours post-ingestion may be discharged.      

    For further information contact poisons information 13 11 26