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Nonsteroidal Anti-inflammatory Poisoning, Emergency Medicine

Michele Zell- Kanter Reviewed 06/2017
 


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...

Diagnosis

Signs and Symptoms

  • GI:

    • Nausea

    • Vomiting

    • Epigastric pain

  • CNS:

    • Drowsiness

    • Dizziness

    • Lethargy

    • Aseptic meningitis

    • Seizures

  • Cardiovascular:

    • Hypotension

    • Tachycardia

  • Pulmonary:

    • Eosinophilic pneumonia

    • Apnea

    • Hypervent...

Treatment

Pre-Hospital

Collect prescription bottles/medications for identification in the ED. 

Initial Stabilization/Therapy

Ed Treatment/Procedures

Follow-Up

Disposition

Admission Criteria

  • Protracted vomiting, hematemesis

  • CNS depression, seizure activity

  • Metabolic acidosis

  • CHF, hypotension, hypertension

  • Renal failure

Discharge Criteria

Nontoxic ingestion...

Pearls and Pitfalls

  • Investigate for coingestions for all NSAID overdoses.

  • Obtain acetaminophen and salicylate level on all patients who present with suspected NSAID ingestion.

  • NSAID poisoning is general...

Additional Reading

  • Dajani  EZ, Islam  K. Cardiovascular and gastrointes–tinal toxicity of selective cyclo-oxygenase-2 inhibitors in man. J Physiol Pharmacol.  2008;59(suppl 2):117–133.

  • Frei  MY, N...

Codes

ICD9

976.0 Poisoning by local anti-infectives and anti-inflammatory drugs 

ICD10

  • T39.391A Poisoning by other nonsteroidal anti-inflammatory drugs, accidental, init?

  • T39.392A Poisoning by other nonst...

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