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Nonsteroidal Anti-Inflammatory Poisoning

Nonsteroidal Anti-Inflammatory Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Inhibit cyclooxygenase (COX), thereby blocking the conversion of arachidonic acid to prostaglandin.
  • Typically morbidity is low when an NSAID is ingested
  • Most literature on nonselective NSAID toxicity involves ibuprofen exposure likely due to its OTC availability.
  • Fatalities have been reported with large ingestions.
  • Greater potential for toxicity with underlying CHF or renal failure:
    • NSAIDs cause sodium and water retention and decrease renal blood flow.
    • Little overdose experience with the COX-2 inhibitors (celecoxib); treatment should be the same as for the traditional NSAIDs.
    • Patients may ingest rofecoxib and valdecoxib from stored supplies even though both are no longer available in US

Etiology

  • Nonsteroidal medications are available by prescription and over-the-counter.
  • NSAIDs include:
    • Diclofenac
    • Diflunisal
    • Etodolac
    • Fenoprofen
    • Ibuprofen
    • Indomethacin
    • Ketoprofen
    • Ketorolac
    • Meclofenamate
    • Meloxicam
    • Nabumetone
    • Naproxen
    • Oxaprozin
    • Piroxicam
    • Sulindac
    • Tolmetin

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Citation

Rosen, Peter, et al., editors. "Nonsteroidal Anti-Inflammatory Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307598/all/Nonsteroidal_Anti_Inflammatory_Poisoning.
Nonsteroidal Anti-Inflammatory Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307598/all/Nonsteroidal_Anti_Inflammatory_Poisoning. Accessed April 25, 2019.
Nonsteroidal Anti-Inflammatory Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307598/all/Nonsteroidal_Anti_Inflammatory_Poisoning
Nonsteroidal Anti-Inflammatory Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307598/all/Nonsteroidal_Anti_Inflammatory_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Nonsteroidal Anti-Inflammatory Poisoning ID - 307598 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307598/all/Nonsteroidal_Anti_Inflammatory_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -