![]() Baseline bloods (EUC, LFTs, FBC, VBG/ABG, Lactate, Coagulation) to monitor for end organ damage.NSAID levels are not routinely available.Screening: 12 lead ECG, BSL, Paracetamol level.If intubated see FASTHUGSINBED for further supportive care.Large overdoses progress to multi-organ failure, shock, coma, seizures, metabolic acidosis.Most patients are asymptomatic, progressing to GI (nausea, vomiting, epigastric pain), minor CNS (lethargy and drowsiness).Chronic ibuprofen use is associated with renal tubular acidosis and potentially life-threatening hypokalaemia.Any child who has taken <100 mg/kg does not need assessment unless they are symptomatic. Children: Significant symptoms are not usually observed until doses exceed 300 mg/kg of ibuprofen or equivalent.Overdose of mefenamic acid at any dose can cause self limiting seizures, any adult or child needs assessment in hospital.300 mg/kg Risk of multi-system organ dysfunction – fatalities have been reported.Can be managed with benzodiazepines (varying doses in the textbooks, easy method is 0.1mg/kg IV for lorazepam (max 4mg) / midazolam (max 10mg) / diazepam (max 10mg).Check the patient is not in a dysrhythmia.During intubation and ventilation it is paramount not to exacerbate the metabolic acidosis (risk of death) therefore pre-intubation a bolus of sodium bicarbonate 1-2 mmol/kg followed by hyperventilation and further boluses of sodium bicarbonate is best practice. Patients usually compensate the metabolic acidosis with a high respiratory rate.CNS depression: If there is any doubt over the patients ability to protect their own airway or you believe they are an aspiration risk they will require intubation and ventilation.Half life is less than 4 hours except longer acting agents such as naproxen (12 hours).Hepatic metabolism and renal excretion.They directly irritate the gastrointestinal tract, increase bleeding time (inhibit thromboxane A2) and cause a renal glomerular vasoconstriction (prostaglandin inhibition). ![]() NSAIDs competitively block COX-1 and COX-2 therefore inhibiting prostaglandin synthesis. ![]() As 66% of NSAID overdoses are with ibuprofen we will use this as an example. NSAIDs are generally benign in overdose unless a large amount is ingested which would take some effort.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |